What criteria should I use to determine if a frail patient requires referral to a specialist for further assessment?

Criteria for referring a frail patient to a specialist for further assessment include:

• When the patient has multiple long-term conditions and social care needs that are likely to increase significantly, impacting their wellbeing or indicating potential need for nursing or care home placement, referral to a geriatrician or old-age psychiatrist should be considered to guide social care planning.
• Referral should be considered if the patient’s recovery is slower than anticipated according to rehabilitation goals or if new physical or non-physical morbidities develop that were not previously identified.
• Referral is appropriate when the patient shows signs of cognitive impairment, delirium, or psychological distress that adversely affect rehabilitation or engagement with care.
• Referral should be made if there are specific clinical indications such as rapidly progressive neurological symptoms, suspected cancer, or complex rehabilitation needs requiring specialist input (e.g., orthogeriatrician for fragility fractures, bone health clinic, psychological therapy, or other specialist rehabilitation services).
• In all cases, the patient’s preferences and involvement in decision-making should be ensured, and information should be provided in an accessible format.

These criteria ensure that frail patients receive timely specialist assessment to address complex medical, psychological, and social needs, improving outcomes and care coordination.

References: NICE NG22, NICE CKS, NICE CG103, NICE NG127, NICE NG12