Frailty Alerts Reduce Waiting Time and Length of Stay in the Emergency Department

Abstract

Background: Prolonged emergency department waiting times are associated with increased mortality among older patients. In January 2025, the ED of Linkoping University Hospital, Sweden, implemented a low-resource routine to expedite the workup of older patients living with frailty by prioritized physician assessment and subsequent workup.

Aim: To investigate if a frailty alert using the Clinical Frailty Scale followed by prioritized clinical assessment influences ED operating metrics.

Design: This was an observational before and after study of a pre-implementation group (control) and a post-implementation group (intervention) between October 2024 and February 2025.

Setting/participants: Consecutive patients aged > 64 years, with a documented CFS assessment during the ED visit at the Linkoping University Hospital, Sweden, who consented to participation, were included.

Method: Standard ED operating metrics, Time to physician, ED length of stay (LOS), and admission rates were compared between a pre-implementation group and a post-implementation group.

Results: A total of 542 ED visits were analyzed (248 pre-implementation, 294 post-implementation). Time to physician was shorter in the post-implementation group at 31 min (IQR 15, 65) versus 44 min (IQR 20, 94) (p < 0.001). ED LOS was reduced from 352 (IQR 266, 515) to 319 (IQR 240, 458) minutes (p = 0.014). The admission rate was unchanged at 59% and 60% (p = 0.4).

Conclusion: Frailty alerts based on the CFS with prioritized workup reduced ED LOS and time to physician in older patients living with frailty in this single center study and may be a low-resource intervention to reduce the risks of adverse events in the ED.

Trial registration: ClinicalTrials.gov identifier: NCT06869148.