Implementation Insights of a Hospital-Based Nurse-led Frailty Assessment and Management Programme

Year Submitted: 2025
Published Date: 13 January 2026

Tags: Applied/Translational Research, Qualitative Research, Quantitative Research

About this Content

Aims

Tan Tock Seng Hospital's new Inpatient Nursing Frailty Assessment (INFA) programme involves nurses screening for geriatric syndromes in mild-to-moderately frail older patients and facilitating multidisciplinary management. We aimed to conduct a systematic multi-method two-phased implementation research study, before (pre-) implementation and during early implementation, to assess and increase the likelihood of successful adoption and implementation.

Background

With populating ageing, hospital systems are grappling with caring for an increasing number of frail older individuals. This warrants forging a frailty-ready hospital system across medical specialties. Yet, a gap exists in managing frailty among older patients in non-geriatric acute wards. We explored INFA’s anticipated implementation barriers and facilitators before implementation to develop targeted strategies for optimising actual implementation. Subsequently, INFA’s adoption and implementation alongside fidelity to strategies were assessed during implementation.

Methods

Before implementation, we employed qualitative inquiry by conducting 11 focus group discussions and in-depth interviews with 25 healthcare administrators and frontline implementers underpinned by maximum variation purposive sampling. Data collection and analysis were guided by the updated Consolidated Framework for Implementation Research. Data was synthesised using deductive-inductive approach and framework
analysis. During implementation, we analysed quantitative process indicators for care processes, and fidelity indicators informed by Proctor's framework for reporting and specifying implementation strategies (actor, action, target, dose, temporality).

Results

INFA's systematic and proactive approach to bridge frailty care gaps was anticipated to facilitate adoption and implementation. Anticipated implementation barriers were related to compatibility with existing workflows, competing priorities across specialist departments, capability gaps, and interprofessional communication. Within the first 4 months of implementation, a high proportion of eligible patients completed
screening (n=161 of 164, 98.2%). Strategies developed and operationalised to optimise adoption and implementation were reported to have moderate-high fidelity. These included capability building, interprofessional implementation team meetings, and changes to IT systems.

Conclusion

INFA's nurse-led care model demonstrates the extension of frailty care management to non-geriatric medical wards. The programme's high adoption shows its implementability in real-world practice and potential for scale-up, alongside being a potentially cost-efficient model driven by nurses and pre-existing nursing assessments. Nevertheless, long-term scalability and sustainability of the programme need to be further studied. We disseminate generalisable knowledge on novel approaches to integrating implementation science to facilitate implementation of hospital-based programmes in real-world contexts.

Lessons Learnt

Nurse-led frailty care models can be transformative by empowering nurses, harnessing multidisciplinary strengths, and bridging fragmented care delivery. Realising these potentials by optimising adoption and implementation in real-world settings requires:
o Systematic methods to proactively identify and address contextual barriers through strategies
o Adapting interventions to the clinical context, ensuring they are feasible, compatible, and sustainable

Additional Information

This study attained the Singapore Young Investigator Award (Health Services Research) at the Singapore Health & Biomedical Congress 2025’s scientific competition. This research is funded by the Geriatric Education & Research Institute's (GERI) intramural grant [Reference No. GERI1634]. The study protocol can be accessed via the following link: https://doi.org/10.1186/s12877-025-06861-1

Keywords

Frailty, Implementation science, Geriatric syndromes, Acute inpatient care, Nursing assessment

Innovators' Details

Connect with this contributor!

Araviinthansai Subramaniam - subramaniam.araviinthansai@geri.com.sg

Project Attachment

(YIA-HSR-06) Poster 2025 (Araviinthansai)_Latest.pdf