Not Just Can We, But Should We? Implementing an ED Frailty Intervention Team and a Turn Toward Realistic Medicine

Abstract Background Frailty affects a significant proportion of patients attending emergency departments (ED), with estimates suggesting 10% of ED attendees and 30% of acute medical admissions are living with frailty. Delayed access to Comprehensive Geriatric Assessment (CGA) increases the risk of deconditioning, delirium, prolonged hospital stays and poorer outcomes. This project piloted a Frailty Intervention Team (FIT) in the ED, initially focused on early discharge, which evolved to support the principles of Realistic Medicine. Realistic Medicine seeks to ensure patient care is appropriate, evidence-based, and aligned with what matters most to patients and their families. Methods Over a four-week pilot in the ED of a large teaching hospital, 100 patients aged ≥75 with Clinical Frailty Scores ≥6, referred for medical admission, were assessed by a team comprising 1 geriatrician and 3 specialist nurses. Patients were identified via ED whiteboards and assessed face-to-face or virtually depending on resource availability and patient need. Where appropriate, elements of CGA were completed. Data collected included demographics, frailty scores, cognition, reason for attendance, intervention, and outcomes. Results The median age was 85. 71% lived at home and 47% had a diagnosis of dementia. CGA was initiated in 72% of cases. Early discharge was recommended in 42%, with 31% discharged within 24 hours. The 28-day readmission rate for this group was 17%. While the original aim was to identify alternatives to admission, the team’s role expanded—creating space for shared decision-making, anticipatory care planning, and aligning care with patient goals. This included avoiding burdensome interventions in those with life-limiting conditions, including advanced dementia and severe frailty. Conclusion Implementing an ED-based FIT enabled earlier, person-centred conversations and supported a cultural shift toward Realistic Medicine. The approach allowed for personalised care and multidisciplinary collaboration. Future service evaluation will include patient and staff feedback to further inform development and sustainability.