Galway University Hospitals service helps older people remain well at home


By the end of 2023, over 2,200 older patients had benefitted from targeted assessment and interventions to help them remain well at home from a new Frailty at the Front Door (FFD) service at Galway University Hospitals.

It began in 2021 and consists of a team of physiotherapists, clinical nurse specialists, occupational therapists and geriatricians who work with patients over the age of 75 who present to the Emergency Department with frailty. This usually arises after a fall or because of changes in a patient’s ability to complete everyday tasks. The service uses a holistic and multi-disciplinary approach to help these patients avoid a hospital stay by intervening at the earliest point in the patient’s journey – at the front door in the Emergency Department.

Many older patients express a preference to recover from a health setback in their own home and a large part of the FDD service involves supporting the patient with a safety net of clinical services when they are discharged from the Emergency Department.

In 2023, the team supported discharge directly to home in over 60% of frailty cases presenting to the Emergency Department. This involved working with colleagues in Galway’s Integrated Care Programme for Older Persons to ensure that patients could safely recover at home with access to the appropriate clinical specialists as and if required.

Orla Sheil, a Senior Occupational Therapist in the FDD service, described some of the work carried out by the team, “Early assessment means we find out what’s important to our patients and what their needs are. Early intervention means we find ways to support their safe recovery at home. This approach has really significant outcomes both in terms of patient flow in the hospital setting and it also leads to shorter length of stay. It further enhances mobility, recovery and independence for our frailty patients.

“Some of the interventions we carry out include a review of medications; addressing incontinence issues; assessing mobility; providing exercise and activity programmes; recommending necessary equipment to maintain independence at home and linking patients with resources in their own community to better manage their own health.”

Dr Cliona Small, Consultant Geriatrician, said, “The Frailty at the Front Door service here in Galway is in constant evolution. We are continually developing and expanding the service to meet increasing demands. Our overall goal is to prevent hospital-acquired disability by reducing hospital stays for frail patients and facilitating a safe discharge home with appropriate follow-up. It’s important to note that this service is only one component of a patient’s journey with the healthcare system and we work closely with community care teams and our integrated care colleagues to provide optimal care to our older patients.”

The frailty service is part of the Enhanced Community Care programme (ECC) to improve and expand community health services and reduce pressure on hospital services. The National Integrated Care Programme for Older Persons aims to develop primary, secondary and acute care services for older people with a specific focus on those with more complex needs and frailty.