Effects of an acute emergency department and outpatient frailty service on reducing re-attendance rates in patients aged over 75

Abstract

Background This level 3 hospital has a frailty pathway in place since 2016, consisting of a frailty team within the emergency department (ED) and an outpatient hub. Patients that are seen by the frailty team in ED, undergo a comprehensive geriatric assessment by a specialist multidisciplinary team, and if suitable for discharge are followed up within 1-2 weeks by the outpatient team. Two principle objectives of the frailty pathway is to minimise ED length of stay and admission avoidance in this vulnerable cohort. This audit examines the likelihood of re-attendance to ED in patients over 75 years if seen by a frailty team. Methods Data were collected using hospital IPMS software examining all attendances in January 2025. Data were then analysed to focus on the audit objective. Results In January 2025, 731 people over the age of 75 attended this level-3 hospital ED, of which 402 (55%) were classified as being frail at triage. 179 (24.5%) of this patient cohort re-attended the ED during the course of January. Of this group, 52 (7.1%) of all attendees re-presented within 7 days, 29 (4%) within 14 days and 19 (2.6%) within 30 days. The ED frailty team saw 183 (25%) of overall attendees, of which 72% were frail. Within this cohort of patients, the total number of re-attendances was 9 (4.9%), with 3(33.3%) re-presenting within 7 days, 4(44.4%) within 14 days and 2(22.2%) within 30 days. Conclusion Patients over 75 years of age attending this level-3 emergency department were less likely to re-attend within 30 days if seen by the frailty team on arrival (4.9% vs 7.1%). Prompt intervention by a specialist multidisciplinary geriatric team in ED, with early interval outpatient follow-up, has a protective influence against repeat hospital presentations.