The challenges of using the Hospital Frailty Risk Score - Author's reply

We thank John Soong and colleagues, Sandra M Shi and Dae H Kim, and Rónán O'Caoimh and colleagues for their careful consideration of our Article. We note some concerns about the clinical utility of our scoring method; our approach is to position the Hospital Frailty Risk Score (HFRS) as a tool that can be implemented without the need for additional assessment or data collection, and direct high-risk individuals towards frailty-attuned interventions, such as the Comprehensive Geriatric Assessment (CGA).1 We acknowledge that the HFRS can only be generated after an initial admission, so risk stratification information would not be possible at first presentation. Two-thirds of people aged 75 years or older access acute-care hospitals more than once over a 2-year period, and those patients who have not previously accessed hospital care are typically at low risk of hospital-related adverse outcomes; thus, we view the HFRS as being especially useful to identify individuals at the highest risk of hospital-related harm and resource use. We accept that manual scales, such as the Clinical Frailty Scale,2 could be used, but the HFRS has the advantage of being automated and capturing all patients, not just a selected sample