Service provision for Frailty in European Emergency Departments (FEED): a survey of operational characteristics
Authors: Fehlmann Christophe A. , Mc Loughlin Kara , Cosgriff Emma Jane , Ferrick John Francis , van Oppen James David ,   European Taskforce for Geriatric Emergency Medicine, Coats Timothy , Conroy Simon , de Groot Bas , Heeren Pieter , Lim Stephen , Lucke Jacinta , Mooijaart Simon , Nickel Christian H. , Penfold Rose , Singler Katrin , Heeren Pieter , Steenebruggen Françoise , Sterckx Valerie , Brdar Ivan , Libicherová Pavla , Balen Frédéric , Bianco Céline , Dubucs Xavier , Guenezan Jérémy , Apfelbacher Stefanie , Fraidakis Othon , Fyntanidou Varvara , Gaál Szabolcs , Jónsdóttir Anna Björg , Cremin Maria , Kelly Mary , McAteer Claire , Moloney Elizabeth , Sankey Ciara , Sibthorpe Lisa , Zazzara Maria Beatrice , Camilleri Rene Alexander , Zammit Paul , Coffeng Sophie M. , Lucke Jacinta , Smits Rosalinde , Bordigoni Miguel Alberto Rizzi , Castejón-Hernández Santiago , del Rocio Coronel Chumbi Lupe , Mir Sira Aguiló , Padilla Eduardo Enrique , Rojewski-Rojas Wojciech , Fadini Davide , Jegerlehner Natalie Sabrina , Nickel Christian H. , Zucconi Enrico , Demir Hüseyin Avni , Dundar Zerrin Defne , Güven Ramazan , Karamercan Mehmet Akif , Kose Fulya , Söğüt Özgür , Tayfur Ismail , Abbott Lucy , Adams James , Bernardo Janice , Brown Leanne , Burton Joel , Claassen Renate , Cooper Jamie , Heyes Ruth , Lightbody Calvin , Masoli Jane , Mawhinney David , McKenzie Stephen , Moultrie Nicola , Price Angeline , Raman Rajendra , Rajasingam Apirthan , Rothwell Lauren , Shashikala Ravishankar Prabhakar , Smith Erica , Sorice Vittoria , van Oppen James , Wallace James , Young Tom , Polyzogopoulou Effie , Llauger Lluís 
Published: July 2024

Abstract
Background
The observational Frailty in European Emergency Departments (FEED) study found 40% of older people attending for care to be living with frailty. Older people with frailty have poorer outcomes from emergency care. Current best practice calls for early identification of frailty and holistic multidisciplinary assessment. This survey of FEED sites explores variations in frailty-attuned service definitions and provision.

Methods
This cross-sectional survey included study sites across Europe identified through snowball recruitment. Site co-ordinators (healthcare professionals in emergency and geriatric care) were surveyed online using Microsoft Forms. Items covered department and hospital capacity, frailty and delirium identification methods, staffing, and frailty-focused healthcare services in the ED. Descriptive statistics were reported.

Results
A total of 68 sites from 17 countries participated. Emergency departments had median 30 (IQR 21–53) trolley spaces. Most defined "older people" by age 65+ (64%) or 75+ (25%). Frailty screening was used at 69% of sites and mandated at 38%. Night-time staffing was lower compared to day-time for nursing (10 [IQR 8–14] vs. 14 [IQR 10–18]) and physicians (5 [IQR 3–8] vs. 10 [IQR 7–15]). Most sites had provision for ED frailty specialist services by day, but these services were rarely available at night. Sites mostly had accessible facilities; however, hot meals were rarely available at night (18%).

Conclusion
This survey demonstrated variability in case definitions, screening practices, and frailty-attuned service provision. There is no unanimous definition for older age, and while the Clinical Frailty Scale was commonly used, this was rarely mandated or captured in electronic records. Frailty services were often unavailable overnight. Appreciation of the variation in frailty service models could inform operational configuration and workforce development.