Embedding an Enhanced Frailty Service into Urgent and Emergency Care

In 2021, Cardiff and Vale University Health Board’s average length of stay (LOS) in Assessment Unit (AU) for over 75-year-olds was 24.2 days, due to long waits for inpatient beds. Once admitted, 23% of patients moved wards three or more times. Patient experience scores indicated poor satisfaction levels, with nearly 50% of patients feeling their needs had not been met. Staff consensus was that the environment was unsuitable for older patients.

The implementation of an enhanced frailty service began in November 2022. This was managed by a geriatrician-led team, with support from junior doctors and Physician Associates. The provision consisted of a 6-day service for the Frailty Zone, an allocated area of 12 beds in AU, an in-reach service, and input from the therapy and nurse led Frailty Intervention Team (who specialise in admission avoidance). Thus, giving the team wider reach, and ensuring frailty input from the beginning of the patients’ journey.

Between December-March 2023, there was a 36% increase in the number of patients discharged directly from AU, in patients aged 75+. This equates to an extra 21 discharges per week. The average LOS in AU reduced by 6.9 hours. Notably, the LOS for patients under 75 remained largely unaffected during this time. The number of ward transfers for this population also reduced to 13%.

The data obtained from the frailty service led to additional service development. In July 2023, the expansion of the Frailty Zone into a 19 bed Older Persons Acute Medical Unit came into effect. Staff feedback remains positive, with boosted morale. However, there is more development needed in way of communicating with all members of staff.Expansion of the Frailty Intervention Team is being developed to provide patients who are likely to need admission access to therapy and frailty nurses.