Identifying frail patients at the front door: a quality improvement project on improving identifying frailty and accuracy of Clinical Frailty Scale in the emergency department in an acute general hospital.

Abstract

Background: The rise in frail patients seeking care at emergency departments (ED) globally has led to an increased focus on improving the identification and care of frail patients on arrival in ED. The Clinical Frailty Scale (CFS) has been used in the ED to identify frail elderly patients and prompt the initiation of a comprehensive geriatric assessment. However, it has been noted that the CFS's accuracy was low, and training needs have been identified.

Methods: To address this, a quality improvement project was carried out using the PDSA (Plan, Do, Study and Act) cycle to enhance the accuracy of frailty identification at the front door. Standards for Quality Improvement Reporting Excellence guideline is followed to report.

Intervention: Based on the fishbone and driver diagram, a training programme was designed and delivered to the ED nurses in November 2023 (PDSA cycle 1) and from September to October 2024 (PDSA cycle 2). A lanyard card was developed to simplify and standardise the CFS scoring. This was disseminated to ED nurses along with 1:1 brief education in conjunction with other training activities.

Results: Following the training intervention, the correct identification of CFS 6 and above improved from a baseline of around 50% to around 60% after the first cycle and to over 70% after the second cycle. While the accuracy of CFS also improved to 40%, it remains to be seen whether this change is sustainable and not just a normal variation.

Conclusion: This quality improvement project, using a lanyard card, in conjunction with brief teaching and other training methods, effectively increased the rate at which moderate to very severely frail frailty was identified and subsequently referred to frailty teams.