Aims
Reduce the proportion of admissions for patients over 65 years from ED to the wards with early identification and management of frailty by introducing frailty screening and intervention with an “acute frailty team”.
Methods
Initiative was supported through the Victorian Department of Health’s Timely Emergency Care Program, utilising improvement science principles to continuously learn from ‘Plan-Do- Study-Act’ cycles to iterate the change
Work commenced with small scale utility testing of the Clinical Frailty Scale (CFS) within the Emergency Department (ED) by Geriatricians, Allied Health and Nurses. Testing demonstrated that while the CFS could be completed in the ED, to optimize upfront identification, screening needed to be incorporated into existing electronic workflows and linked to intervention.
Existing clinicians including; Geriatricians in ED (GEDi), Nurse Practitioners and ED Care Coordinators worked with dedicated Allied Health Geriatric Advanced Practitioners (GAPs) to form an Acute Frailty Team. Patients with CFS score ≥ 4 were reviewed to identify immediate care needs, functional criteria for discharge and plan for home.
Results
From July–December 2025, the AFT reviewed 348 additional patients and diverted 158 from admission. Across the organisation, the proportion of admissions for patients aged ≥65 years decreased by 3%, and ED length of stay was reduced by 5.5 hours. Embedding CFS screening into nursing workflow improved consistency and enabled earlier frailty identification.
Conclusions
Frailty screening using the CFS is feasible, effective, and supports interdisciplinary frailty intervention in the ED to safely reduce admissions.