The Bath Frailty Big Room


The Frailty Big Room at the Royal United Hospitals Bath NHS Foundation Trust is focused on all patients over the age of 75 with frailty admitted to the hospital.  The aim to have the shortest possible length of stay.  The pathway is set against the backdrop of increasing demand on frail elderly services resulting in unsustainable pressure for the acute service, poor experience for patients and their families and increasing costs for commissioners.  The RUH Frailty Model Flow Programme supports the Older Persons Short Stay Unit to improve the flow of patients through their care pathways to improve patient experience, safety and efficiency.

Frailty Global Aim : To have the shortest possible length of stay for frail older people

After establishing a weekly 'Big Room' meeting inviting all the MDT stakeholders across the frail elderly pathway, the team used the 5Vs assessment structure (Value, inVolve, Visualisation, eVidence, Vision) to start to understand this complex system.  They began with speed mapping, then generated themes, brainstormed ideas for improvement and then multi-voted to agree areas to focus on.  This developed into a vision (pictured below - click on the image for the full size document) and set the programme of work for the Big Room. 

Workstreams were identified with a focus on the Front Door, specifically;

  • Discharge assessment teams (DAT)
  • Frailty Scoring and Comprehensive Geriatric Assessment (CGA)
  • Direct admissions to ACE ward from the Emergency Department
  • Frailty Flying Squad (completely developed, named and tested through the Big Room as a result of wanting more senior input at the Front Door).

As a result PDSA testing of a medical proforma for > 75 years old admissions was agreed and used for all medical admissions. The frailty score was logged by IT as a development for the hospital PAS system. A Frailty Flying Squad idea evolved over a series of Big Room before the PDSA was designed and tested over an 8 week period.  From this a business case was developed and approved.


  • Decision To Admit time reduced by 14 minutes to 118 mins
  • 22% of frail elderly patients were seen and discharged the on the same day 
  • A further 13% were discharged within 24 hours  
  •  Readmission rate stayed low at 9.4%
  • Average Length of Stay has reduced (see run chart below)

In addition, the team report that new relationships have been formed, communication has improved and frailty is now well integrated into ED and across the Front Door.  Two additional Big Rooms have been established, the Specialty Big Room and the Ambulatory Care Big Room, which have also begun delivering measurable improvements.

Without the Big Room we would not have achieved everything we have. I have never been part of something which has delivered, in a relatively short space of time, sustained change.  It’s about the basics, good and regular communication. (ED Consultant, RUH Bath)

The Bath Frailty Big Room Team have been shortlisted for the 2017 Nursing Times Award in the category of 'Care of Older People'.

Bath Frailty Big Room Coaches - 

  • Dr. Chris Dyer, Consultant Geriatrician
  • Sarah Hudson, Deputy Divisional Manager Medicine

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