Frailty Same Day Emergency Care

Frailty Same Day Emergency Care (FSDEC) is a new service based in the Portesham Unit.

Our aim is to assess older people living with frailty who are at risk of acute admission or Emergency Department (ED) attendance who need access to diagnostics and investigations. It is staffed by advanced clinical practitioners with access to consultant geriatricians.

FSDEC aims to:

• provide a responsive and flexible service to frail, older people who can be managed via an SDEC pathway
• reduce ED waiting times for older people to a minimum and provide a positive user experience
• to deliver a CGA using specialist skills and an MDT approach
• support community services to access timely diagnostic services for people at risk of unplanned attendances.

Some patients with frailty may present with non-specific symptoms rather that the ‘textbook’ presentation of conditions. These may include:

• falls (e.g. collapse, legs gave way, ‘found lying on floor’)
• immobility (e.g. sudden change in mobility, ‘gone off legs’ ‘stuck in toilet’)
• delirium (e.g. acute confusion, ’muddledness’, sudden worsening of confusion in someone with previous dementia or known memory loss)
• incontinence (e.g. change in continence – new onset or worsening of urine or faecal incontinence)
• susceptibility to side effects of medication (e.g. confusion with codeine, hypotension with antidepressants).

For some patients with frailty, it may not be appropriate to use this service. This may include:

• patients requiring specialist intervention e.g. suspected strokes and fractures
• surgical complication
• head injury
• Patient under specialised outpatient care
• Patients with suspected infectious symptoms e.g. influenza, RSV, C Diff.