The Discharge of Elderly Patients from an Accident and Emergency Department: Functional Changes and Risk of Readmission

Rowland, Kathryn; Maitra, A K; Richardson, Diane; Hudson, Kathryn Elizabeth; Woodhouse, K. W.

doi:10.1093/ageing/19.6.415

Cited by 115 publications

(85 citation statements)

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“…(23)(24)(25)(26)(27) The Triage Risk Screening Tool (TRST), a six-item tool comprised of yes/no questions that are completed during the triage process, has been evaluated for use in older patients being discharged from the ED. (24,28) It evaluates the presence of cognitive impairment, difficulty walking or transferring, recent falls, living alone with no available caregiver, taking five or more prescription medications, ED use in previous 30 days or hospitalization in previous 90 days, and registered nurse (assessor) concern.…”

Section: Frailty In Emergency Department Patientsmentioning

confidence: 99%

“…(27) The BRIGHT requests the patient or caregiver to think about the previous three months and respond with "yes" or "no" to questions related to functional problems, shortness of breath, mobility problems, cognition, falls, self-rated health, and depression. (27) The final two screening tools identified were the sevenitem questionnaire developed by Rowland et al (26) and an eight-item questionnaire by Ruciman et al (25) The sevenitem screening primarily assesses function (activities of daily living (ADL) and instrumental activities of daily living (IADLs)) and mobility. A score of four or more would identify an individual at risk for re-admission.…”

Section: Frailty In Emergency Department Patientsmentioning

confidence: 99%

“…Risk-screening tools have been developed to identify patients at risk for re-admission to the ED, functional decline or death. (23)(24)(25)(26)(27) Although these tools are not attempting to quantify frailty, their components are related to a conceptualization of frailty (e.g., function, mobility, cognitive impairment). For older patients discharged from the emergency department, functional deficits and use of community services were predictive of re-admission.…”

Section: Inter-rater Reliability Not Reportedmentioning

confidence: 99%

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Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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BackgroundOlder adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature.MethodsPubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting.ResultsIn the broad clinical literature, three types of measures can be identified: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature.ConclusionsThere is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

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Section: Frailty In Emergency Department Patientsmentioning

confidence: 99%

Section: Frailty In Emergency Department Patientsmentioning

confidence: 99%

Section: Inter-rater Reliability Not Reportedmentioning

confidence: 99%

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Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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“…3,5 Approximately 10%-45% of the patients will develop a decline in function that persists up to seven months post injury. [3][4][5][6][7][8][9][10][11][12][13] Functional decline, or the reduction in ability to perform self-care activities of daily living (ADL) because of a decrement in physical functioning, [14][15][16][17] is a common and serious problem in elderly patients. 16,17 Functional decline is associated with social isolation, reduced quality of life, and death.…”

Section: Introductionmentioning

confidence: 99%

“…16,17 Functional decline is associated with social isolation, reduced quality of life, and death. 3,5,7,8,14,[18][19][20][21][22] It is also an important predictor of hospitalization, 23,24 prolonged hospital stay, 25 repeat ED visits, 7,26 and the need for home care 25 . Moreover, functional decline is the most important predictor of admission to institutions and of disproportionate use of health services by the elderly population.…”

Section: Introductionmentioning

confidence: 99%

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Abdulaziz

Brehaut

Taljaard

et al. 2015

CJEM

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Background: There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury. Methods: After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method. Results: Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks. Conclusions: A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

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Reduction of 30‐day postdischarge hospital readmission or emergency department (ED) visit rates in high‐risk elderly medical patients through delivery of a targeted care bundle

Koehler

Richter

Youngblood

et al. 2009

Journal of Hospital Medicine

308

298

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Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. OBJECTIVE:To assess the impact of a supplemental care bundle targeting high-risk elderly inpatients implemented by hospital-based staff compared to usual care on a composite outcome of hospital readmission and/or ED visitation at 30 and 60 days following discharge. PATIENTS/METHODS:Randomized controlled pilot study in 41 medical inpatients predisposed to unplanned readmission or postdischarge ED visitation, conducted at Baylor University Medical Center. The intervention group care bundle consisted of medication counseling/reconciliation by a clinical pharmacist (CP), condition specific education/enhanced discharge planning by a care coordinator (CC), and phone follow-up. RESULTS:Groups had similar baseline characteristics. Intervention group readmission/ED visit rates were reduced at 30 days compared to the control group (10.0% versus 38.1%, P ¼ 0.04), but not at 60 days (30.0% versus 42.9%, P ¼ 0.52). For those patients who had a readmission/postdischarge ED visit, the time interval to this event was longer in the intervention group compared to usual care (36.2 versus 15.7 days, P ¼ 0.05). Study power was insufficient to reliably compare the effects of the intervention on lengths of index hospital stay between groups. KEYWORDS: care coordination, discharge planning, elderly care, hospital readmission, transitional care. CONCLUSIONS:Elderly patients (aged 65 years and older) consume a disproportionate amount of acute health care resources, composing up to 20% of emergency department (ED) visits, 1,2 having a 2-fold to 5-fold increase in likelihood of hospital admission, 1 and frequently incurring lengths of hospital stay (LOS) approximately 15% higher than the national averages. 3 In addition, they are at increased risk for hospital readmission in the 90-day interval following hospital discharge. 1,4,5 Specific risk factors for readmission include age above 80 years, discharge within the previous 30 days, the presence of 3 or more comorbid diagnoses, use of 5 or more prescription medications, difficulty with at least 1 activity of daily living (ADL), and lack of discharge education. 6 These risk factors can translate into adverse drug events, 7-9 exacerbations of chronic diseases, 10 or functional decline 4,5 that can trigger ED visits or hospital readmission.Hospital-based care coordination-defined as a multidisciplinary interaction between inpatients and providers that focuses on education, communication, and discharge planning with the primary aim of improving outcomes-has demonstrated inconsistent results as a mechanism to reduce LOS, postdischarge ED visits, or hospital readmission rates. While disease-specific care coordination programs for congestive heart failure and chronic obstructive pulmonary disease have been effective in reducing rehospitalization rates, 10-15 the benefits of comprehensive care coordination for elderly general medical inpatients wit...

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The Discharge of Elderly Patients from an Accident and Emergency Department: Functional Changes and Risk of Readmission

Cited by 115 publications

References 0 publications

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

Reduction of 30‐day postdischarge hospital readmission or emergency department (ED) visit rates in high‐risk elderly medical patients through delivery of a targeted care bundle

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