Geriatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
Geriatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
Rev Esp Geriatr Gerontol. 2024 Sep-Oct;59(5):101512. doi: 10.1016/j.regg.2024.101512. Epub 2024 Jun 8.
To know the impact of a geriatric intervention based on the Comprehensive Geriatric Assessment (CGA) on avoidable admissions in older patients at risk evaluated in the Emergency Department.
Prospective observational unicenter study. We included patients, from October 1, 2018 to January 31, 2020, over 75 years who were attended at the Emergency Department with a Triage Risk Screening Tool (TRST) score≥2. All patients were evaluated by a geriatrician through the CGA. The reasons for going to the Emergency room were collected and also the main intervention carried out by Geriatrics, whether admission or discharge was indicated and whether the admission was avoidable. We did a cost analysis calculating this by (bed/day×average stay×number of admissions avoided).
We included 260 patients, 66% were women and the mean age was 86 years. 73.5% patients had polypharmacy, the mean Charlson index was 2.5 (5.6). 63.3% were independent for walking and 20.8% independent for basic activities of daily living. 59% had cognitive impairment. 91.5% lived at home. The most frequent reason for visiting the Emergency room was decline of general state in 22% and the most frequent intervention carried out by Geriatrics was assistance in the decision making process in 35.4% followed by referral to a preferential outpatient geriatric care circuit in 32.7%. Other interventions carried out by Geriatrics was assistance in clarifying diagnosis (4.2%), assistance in pharmacological adjustment (8.5%), referral to a standard geriatric care pathway (13.1%), telephone follow-up (4.2%) and/or coordination with Social Services for care planning (11.2%). Including all patients, 29.2% required hospital admission and 70.8% were discharged. 40% admissions were avoided, which meant more than 540 thousand euros saved.
A standardized CGA coordinated by Geriatrics in older patients at risk of suffering adverse events in the Emergency room reduces admissions and costs, so it should therefore be established as a recommendation of good clinical practice.
了解基于综合老年评估（CGA）的老年干预对急诊科评估的高危老年患者可避免入院的影响。
前瞻性观察性单中心研究。我们纳入了 2018 年 10 月 1 日至 2020 年 1 月 31 日期间在急诊科就诊的年龄超过 75 岁且分诊风险筛查工具（TRST）评分≥2 的患者。所有患者均由老年病医生通过 CGA 进行评估。收集了去急诊室的原因，还收集了老年病学开展的主要干预措施，包括是否入院或出院，以及入院是否可避免。我们通过（床/天×平均住院时间×避免的入院人数）计算了成本分析。
我们共纳入了 260 名患者，其中 66%为女性，平均年龄为 86 岁。73.5%的患者服用多种药物，平均 Charlson 指数为 2.5（5.6）。63.3%的患者独立行走，20.8%的患者独立进行基本日常生活活动。59%的患者存在认知障碍。91.5%的患者居住在家中。去急诊科的最常见原因是一般状况下降（22%），老年病学开展的最常见干预措施是协助决策过程（35.4%），其次是转诊至优先门诊老年护理通道（32.7%）。老年病学开展的其他干预措施包括协助明确诊断（4.2%）、协助药物调整（8.5%）、转诊至标准老年护理路径（13.1%）、电话随访（4.2%）和/或与社会服务部门协调以制定护理计划（11.2%）。包括所有患者，29.2%需要住院治疗，70.8%出院。有 40%的入院是可以避免的，这意味着节省了超过 54 万欧元。
在急诊科评估的高危老年患者中，由老年病医生协调实施标准化 CGA 可减少入院人数和成本，因此应将其确立为良好临床实践的推荐建议。
