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Tytuł:
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Emergency Department Interventions for Frailty (EDIFY): Front-Door Geriatric Care Can Reduce Acute Admissions.
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Autorzy:
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Chong E; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore; Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore. Electronic address: edward_.
Zhu B; Department of Nursing Services, TTSH, Singapore.
Tan H; Department of Nursing Services, Woodlands Health Campus, Singapore.
Molina JC; Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore.
Goh EF; Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore.
Baldevarona-Llego J; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore.
Chia JQ; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore.
Chong A; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore.
Cheong S; Department of Pharmacy, TTSH, Singapore.
Kaur P; Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore.
Pereira MJ; Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore.
Ng SHX; Health Services and Outcomes Research (HSOR), National Healthcare Group, Singapore.
Foo CL; Emergency Department, TTSH, Singapore.
Chan M; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore; Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore.
Lim WS; Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH), Singapore; Institute of Geriatrics and Active Ageing (IGA), TTSH, Singapore.
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Źródło:
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Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2021 Apr; Vol. 22 (4), pp. 923-928.e5. Date of Electronic Publication: 2021 Mar 03.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2005- : [New York?] : Elsevier
Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins, c2000-
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MeSH Terms:
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Frailty*/therapy
Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Geriatric Assessment ; Hospitalization ; Humans ; Male ; Patient Discharge
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Contributed Indexing:
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Keywords: Acute; emergency medicine; frailty; front-door; geriatrics; hospitalization
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Entry Date(s):
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Date Created: 20210306 Date Completed: 20210701 Latest Revision: 20210701
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Update Code:
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20240104
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DOI:
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10.1016/j.jamda.2021.01.083
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PMID:
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33675695
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Objectives: The EDIFY program was developed to deliver early geriatric specialist interventions at the emergency department (ED) to reduce the number of acute admissions by identifying patients for safe discharge or transfer to low-acuity care settings. We evaluated the effectiveness of EDIFY in reducing potentially avoidable acute admissions.
Design: A quasi-experimental study.
Setting: ED of a 1700-bed tertiary hospital.
Participants: ED patients aged ≥85 years.
Measurements: We compared EDIFY interventions versus standard care. Patients with plans for acute admission were screened and recruited. Data on demographics, premorbid function, frailty status, comorbidities, and acute illness severity were gathered. We examined the primary outcome of "successful acute admission avoidance" among the intervention group, which was defined as no ED attendance within 72 hours of discharge from ED, no transfer to an acute ward from subacute-care units (SCU) within 72-hours, or no transfer to an acute ward from the short-stay unit (SSU). Secondary outcomes were rehospitalization, ED re-attendance, institutionalization, functional decline, mortality, and frailty transitions at 1, 3, and 6 months.
Results: We recruited 100 participants (mean age 90.0 ± 4.1 years, 66.0% women). There were no differences in baseline characteristics between intervention (n = 43) and nonintervention (n = 57) groups. Thirty-five (81.4%) participants in the intervention group successfully avoided an acute admission (20.9% home, 23.3% SCU, and 44.2% SSU). All participants in the nonintervention group were hospitalized. There were no differences in rehospitalization, ED re-attendance, institutionalization and mortality over the study period. Additionally, we observed a higher rate of progression to a poorer frailty category at all time points among the nonintervention group (1, 3, and 6 months: all P < .05).
Conclusions and Implications: Results from our single-center study suggest that early geriatric specialist interventions at the ED can reduce potentially avoidable acute admissions without escalating the risk of rehospitalization, ED re-attendance, or mortality, and with possible benefit in attenuating frailty progression.
(Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
