Íde O'Shaughnessy1, Roman Romero-Ortuno2, Lucinda Edge1, Aoife Dillon1, Sinéad Flynn1, Robert Briggs3, Darragh Shields4, Geraldine McMahon4, Arthur Hennessy4, Una Kennedy4, Paul Staunton4, Rosa McNamara4, Suzanne Timmons5, Frances Horgan6, Conal Cunningham3. 1. Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland. 2. Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Ireland. Electronic address: romeroor@tcd.ie. 3. Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland. 4. Emergency Department, St James's Hospital, Dublin, Ireland. 5. Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland. 6. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
Abstract
BACKGROUND: Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017. AIM: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. DESIGN: Retrospective observational study. METHODS: We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital. RESULTS: In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models. CONCLUSIONS: Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.
BACKGROUND: Older people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017. AIM: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. DESIGN: Retrospective observational study. METHODS: We included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital. RESULTS: In the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models. CONCLUSIONS: Routinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.
Authors: Owen Thorpe; Elva McCabe; Elena Marie Herrero; William Ormiston Doyle; Aoife Dillon; Lucinda Edge; Sinéad Flynn; Anna Mullen; Aisling Davis; Aoife Molamphy; Anna Kirwan; Robert Briggs; Amanda H Lavan; Darragh Shields; Geraldine McMahon; Arthur Hennessy; Una Kennedy; Paul Staunton; Emer Kidney; Sarah-Jane Yeung; Deirdre Glynn; Frances Horgan; Conal Cunningham; Roman Romero-Ortuno Journal: J Frailty Sarcopenia Falls Date: 2022-06-01