Abstract
The acute care system is operating at maximal capacity, A&E is in an ‘awful state’, and there is continual rising of demand [1]. The ageing population is a triumph and challenge, with more living with frailty and complex needs [2]. Demand continues to escalate, and our services need to respond to this new reality [3].
Barnet Hospital is situated within the largest population of older people and with the greatest number of care homes in London. Our local ageing population provides opportunities to develop SDEC services for frail patients traditionally underserved and excluded [4]. For patients ≥65 and ≥80years with CFS≥5, conversion from attendance to admission is 72% and 76% respectively, with mean LOS on our geriatric wards 13.6days [5]. Despite embedded frailty initiatives, the traditional models of inpatient focussed care for those with frailty are unsustainable [3].
Barnet Hospital was an early adopter of Geriatrician and MDT presence within the ED, however a previous iteration of a front-door frailty service was unrecognisable and non-functional in 2024. This was driven by focus on expansion of Geriatric medicine inpatient areas, increasing capacity of rapid-access HotClinic and workforce shortages.
With emerging evidence showing the oldest old waiting longest to be assessed in the ED, frail people waiting longest to be seen on the medical take, and increased mortality of those who remain in ED for longer, a new front-door Frailty Service was never more urgent [6,7,8].
Using quality and service improvement methodology, facilitated by a multidisciplinary working group, a new Frailty Service was planned, piloted and delivered despite staffing and infrastructure challenges. The service expanded, providing CGA to 20patients in June 2024 to over 80patients in January 2025, with 63% same-day discharge rate and excellent patient/carer feedback. With ongoing workforce challenges and changes to dedicated assessment areas, the team have learnt to adapt and work dynamically to provide an ever-improving service.
References:
Darzi A, 2024. Independent Investigation of the NHS in England.
Department of Health and Social Care, 2023. Chief Medical Officer’s Annual Report 2023.
NHSE, 2024. FRAIL Strategy.
GIRFT, 2024. Principles for Acute Patient Care.
Royal Free London NHS Foundation Trust Frailty CPG (Clinical Practice Group), 2024. Barnet Frailty Dashboard.
Maynou L, et al. 2023. Factors associated with older patients’ ED wait times. Emerg Med J.
Knight T, et al. 2023. The impact of frailty and geriatric syndromes on metrics of acute care performance: results of a national day of care survey. E Clin Med.
Iozzo P, et al. 2024. Mortality risk linked to prolonged ED boarding of frail individuals. J Clin Med.