Frailty Screening and Assessment in the Emergency Department: Meeting the Growing Demand with an Expanded Acute Frailty Team

Abstract

Abstract Background Frailty screening and early comprehensive geriatric assessment (CGA) in the emergency department (ED) is recommended to deliver optimal care for older adults with frailty and to reduce associated pressures on hospital systems.1 Interdisciplinary acute frailty teams (AFT) are best placed to lead these specialist assessments and a newly-expanded AFT was launched in February 2024.2 Activity data from the initial months of the AFT’s operations was analysed to understand the patient profile, service demand vs capacity and the impact of the team expansion. Methods A newly-expanded interdisciplinary AFT was launched, including Speech and Language Therapy (SLT) for the first time. Aims were to screen all those aged >70 years in ED for frailty using Clinical Frailty Scale (CFS) and commence CGA where appropriate, during core working hours. Additionally, the team expanded their remit from usually seeing patients pre disposition decision to include those referred for admission. Data reports for AFT activity in the first 55 working days and all-ED >70s presentations in the same time period, including weekends (78 days) were generated and analysed using excel. Results N = 920 patients were seen in the first 55 working days, n=513(53%) female, mean age 79.2 (6.7 SD, range 70-100), 65.4% living with frailty (CFS ≥4), admitted n=581(63%) vs discharged n=339(36%). The AFT saw 36% of all >70s ED presentations. On weekdays, there is a mean demand of n=35.9 (1.4 SD) >70s, and the AFT met 42% of this demand (mean n=15 (2.1 SD)). Compared to the same period in 2023, n=622 (313%) more patients were assessed or screened. Novel services provided were CGA and interdisciplinary team assessments commencing in ED for admitted patients and a SLT ED service. Conclusion An expanded AFT has increased capacity to screen for frailty and commence CGA. Future work will focus on hospital-wide frailty pathways.