Implementing the Clinical Frailty Scale in a Rehabilitation Hospital: A Qualitative Study of Barriers and Facilitators

Abstract

Background: Delayed discharge contributes to prolonged hospital stays, particularly in inpatient rehabilitation. This study explored barriers and facilitators to implementing the Clinical Frailty Scale (CFS) and a frailty intervention bundle in a rehabilitation hospital. Methods: We conducted a qualitative descriptive study using five semi-structured focus groups with 27 clinicians and organizational leaders across three inpatient rehabilitation units at Hennick Bridgepoint Hospital in Toronto, Canada, in July and August 2025. We analyzed data using deductive, directed content analysis informed by the Consolidated Framework for Implementation Research. Results: Facilitators included iterative adaptation, alignment with provincial priorities, training, early staff engagement, leadership support, and ongoing feedback. Barriers included limited perceived added value, duplicate documentation, uncertainty about rehabilitation evidence, community resource shortages, change fatigue, inconsistent information sharing, and weak feedback linking implementation to patient outcomes. Participants viewed the CFS as confirming clinical judgment while providing standardized communication and a shared understanding of risk across care levels. Conclusions: Participants identified contextual fit, workflow integration, and responsiveness to frontline feedback as important facilitators of early implementation. Adaptable, context-sensitive approaches may strengthen future implementation and sustainability of frailty screening and intervention bundles in post-acute rehabilitation.