Embedding an enhanced frailty service into urgent and emergency care

Cardiff and Vale University Health Board

The average length of stay (LOS) within medicine at the University Hospital of Wales (UHW) for over 75s in 2021 was 24.2 days, with long waits for an inpatient bed in the emergency and assessment units (EU/AU). Once admitted, older patients often had multiple ward moves, with only 46% of over 75s leaving hospital after their first admitting ward, whilst 23% moved wards three or more times in 2021.

The Frailty Intervention Team at Cardiff and Vale University Health Board identified the need to extend their successful admission avoidance model further across the acute pathway. A business case was compiled using a value-based healthcare approach, leading to substantive funding for an additional twelve sessions of consultant geriatrician cover. This enabled the opening of a twelve bed 'Frailty Zone' in November 2022 within the existing AU footprint, allowing the expansion of the current “front door frailty” model into an enhanced frailty service covering the entire emergency and acute medicine footprint.

The existing five sessions of consultant geriatrician cover that had previously been used for admission avoidance were changed to a frailty 'in reach' into the remainder of the department, including specialty retrieval of older patients. This allowed the existing admission avoidance Frailty Intervention Team to become nurse and therapist led, reducing unnecessary duplication and expanding the reach of the frailty team across a much wider patient group.

There has been a 36% increase in the number of patients aged 75+ who have been discharged directly from AU since implementation of the enhanced frailty pathway between December 2022 and March 2023. The mean LOS for over 75s in medicine at UHW has reduced by 2.4 days, equating to 3113 bed days saved. Since implementation there has been a 24% increase in the proportion of patients aged 75+ who have no further ward transfers after being admitted from AU.