X-Rays Without the Emergency Department: A Novel Community Model for Frail Older Adults

Introduction
Frail older adults frequently attend the Emergency Department (ED) following falls, where radiography is often the sole reason for conveyance.

Patients with a Clinical Frailty Score (CFS) >4 represent a disproportionate burden of ED attendance and hospital admission.

Delivering mobile community X-ray with advanced paramedic assessment offers an innovative opportunity to prevent unnecessary ED admissions while supporting care closer to home.

Method
An innovative service comprising a radiographer and an advanced paramedic practitioner (APP) reviewed 999 calls and attended suitable patients using a single response vehicle.

Patients under 18 years and those requiring spinal X-rays were excluded.

Frail patients were prioritised, with CFS scoring performed retrospectively.

Patients were more likely to remain at home if imaging was normal.

The service operated from 1 July to 24 October 2025, two days per week, 09:00–17:00.

Results
Thirty-eight patients were referred for mobile X-ray.

Thirty-five (92%) were aged ≥75 years and 35 (92%) had a CFS ≥4.

Thirty-two patients (84%) were from their own home and six (16%) from care homes.

Twenty-five patients (66%) were managed at home; four (11%) had fractures managed conservatively and 21 (55%) had no fracture identified.

Pelvic X-ray was the most requested investigation (13, 28%), with four (31%) fractures identified. Ankle, foot, and wrist X-rays were the next most common (9%).

At St Peter’s ED, 71% of patients aged ≥75 years requiring X-ray were admitted (Oct–Dec 2025).

In this cohort, 23 admissions (92%) were prevented, equating to £81,225 saved.

Annualised modelling demonstrated a net saving of £568,901.

Conclusion
This first-of-its-kind UK community mobile X-ray service safely reduced ED attendance and hospital admission among frail patients while delivering substantial cost savings.

It demonstrates a scalable, patient-centred model to reduce acute care pressures and improve outcomes for vulnerable older adults.