SAFER-f Patient Flow Medicine Bundle

f: Frailty

Use of the SAFER-f Bundle within Nova Scotia Health includes a focus on frailty: the small 'f' of SAFER-f. Although frailty is more common with advancing age, it can be thought of as a life stage that often reflects optimal medical care.

Frailty is a robust predictor of poor health outcomes that matter to patients and health care systems, including:

  • Increased risk of adverse effects from medical and surgical procedures7,8,9
  • Prolonged hospital length of stay10
  • High risk of institutionalization11
  • Functional and cognitive decline12
  • Reduced life expectancy and death13,14,15

Why include frailty in the SAFER bundle?

As our population ages, frailty is becoming more prevalent. This is inevitable.

About one-third of Nova Scotians over the age of 65 are frail. Younger people (under 65) can also be frail.14 The impact of frailty extends across age groups, as well as to essential care partners (i.e. family, friends).

Frail patients have complex needs that take time to address. Given that a focus on a single diagnosis can distract from all the other things that people living with frailty need, health care must develop more organized approaches to improving outcomes in this patient population.

Frailty has been shown to be associated with poor outcomes such as:

  • Increased emergency room visits and hospital admissions11
  • Incomplete recovery following acute illness10
  • Increased length of stay10
  • Falls12
  • Adverse drug events7
  • Need for long term care10
  • Mortality13

As the presence of frailty increases so does the risk of vulnerability and poor outcomes for patients. Assessing and addressing frailty will lead to awareness of those patients at increased risk.

See Frailty Tips sheet for posting on your unit, or for information for patients and their essential care partners: