• Project led by Bangor University.
  • Based on an acute medical unit.
  • Aimed to improve the management and flow of acute medical admissions, including vulnerable and frail patients.
  • Implemented an intelligent triage system where new admissions were assessed by an advanced nurse practitioner using the Simple Clinical Score and Clinical Frailty Scale.

The Bangor University team implemented an advanced triage system on an acute medical unit, to support:

  • targeted early discharge for patients with very low risk of hospital mortality who might be safely discharged to their own home or treated in the community
  • earlier referral for rehabilitation for patients whose main reason for hospital admission is frailty and who require non-acute care
  • earlier escalation of patients who require emergency treatment for life-threatening conditions.

The team reviewed patient data during a control phase before starting the intervention phase. The triage system involved using two tools to assess patients on admission to the unit:

  • The Simple Clinical Score (SCS) - assigns patients to five risk groups according to a summary score based on acute physiology, pre-existing illness and performance status.
  • The Clinical Frailty Scale (CFS) - identifies vulnerable and frail patients to enable the rehabilitation process to start straight away.

Who was involved

The triage system was led by a ‘Navigator’ - an advanced nurse practitioner who was available four days a week during office hours. 


Length of hospital stay was shorter for patients seen by the Navigator in four out of five clinical risk groups. There was no significant difference in average length of stay if comparing the control and intervention phase. One of the reasons for this may have been because the intervention was limited to a fraction of patients.

Taking into account the cost of the Navigator but not the cost of the evaluation team, cost of care was reduced by £482 in patients with very low risk and by £543 for patients with low risk.

Further reading