Frailty stratification in the emergency department using the triage frailty and comorbidity tool

Introduction: Frailty is increasingly recognised as a key determinant of adverse outcomes and resource use in the Emergency Department (ED), yet pragmatic, scalable strategies for timely identification and management are lacking. We evaluated a workflow-compatible frailty stratification model by embedding the Triage Frailty and Comorbidity (TFC) Tool into routine triage for low-acuity patients. Methods: We conducted a multicentre observational study in two Italian EDs. Adult patients triaged as Manchester Triage System (MTS) green/blue were eligible. As part of triage completion, nurses completed the TFC Tool; TFC >= 5% defined positivity. For TFC-positive patients, the waiting-list order was prioritised within the same MTS category. Primary outcome was time from triage completion to medical evaluation; secondary outcome was hospitalisatio n. Results: Among 40,568 eligible visits, 1269 (3.1%) were TFC-positive (0.3% in 18-65 years; 9.8% in >= 65 years). In adjusted models, TFC positivity was associated with a + 1.45 (95%CI 1.19-1.70) minute longer triage duration but reduced waiting time to medical evaluation by -15.06 min (95%CI -20.85 to -9.27). Hospitalisation occurred in 19.4% of TFC-positive vs 4.8% of TFC-negative patients; TFC >= 5% was independently associated with admission (adjusted OR 1.69, 95%CI 1.43-1.99), and TFC as continuous increased admission odds per 1% point (OR 1.05, 95%CI 1.04-1.06 ). Conclusions: Routine implementation of the TFC Tool within standard triage was associated with shorter waiting times to medical assessment among vulnerable low-acuity patients, while maintaining acuity-based prioritisation. TFC positivity was also associated with higher odds of hospitalisation. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.