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Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department

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posted on 28.03.2022, 09:03 authored by Íde O'Shaughnessy, Roman Romero-Ortuno, Lucinda Edge, Aoife Dillon, Sínead Flynn, Robert Briggs, Darragh Shields, Geraldine McMahon, Authur Hennessy, Una Kennedy, Paul Staunton, Rosa McNamara, Suzanne Timmons, Frances HorganFrances Horgan, Conal Cunningham

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.

History

Comments

The original article is available at https://www.ejinme.com/

Published Citation

O'Shaughnessy Í. et al. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med. 2021;85:50-55

Publication Date

24 November 2020

PubMed ID

33243612

Department/Unit

  • School of Physiotherapy

Research Area

  • Population Health and Health Services

Publisher

Elsevier BV

Version

  • Published Version (Version of Record)