Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department
Frailty and multi-morbidity have been associated with increased pressure on Emergency Departments (ED), higher hospital admissions and more risks for patients arising from the ED stay. The advantages of developing specific attention to frailty in ED have been highlighted. The benefits of these approaches are related to patients but also to organizations. The aim is to present how a Program of Care for Frailty (PCF) in an ED impacts on patient flows.
Setting: A tertiary, teaching, 550-bed urban hospital, with 80,000 adult patients/year ED attendances (43% ≥ 65 years). The three main axes of the program are (1) an ED geriatrization, implementing multidisciplinary comprehensive geriatric assessment performed by ED professionals (physician, nurses, social worker, pharmacist); (2) an elder-friendly area (EFA) inside the ED was built; (3) The ED integration in a collaborative network with others healthcare providers in the territory for a shared urgent care.
Between 2011 and 2017, we observe a progressive increase in ED activity (+ 8.1%), in patient’s age (40.9% vs 42.8% ≥ 65 years), and an increase in ambulance arrivals (+ 25.1%). The admission rate was rising until 2014 (10.8–12%). In 2014, the ED geriatrization began and networking was reinforced, and a decrease in the rate of admission (11.3%) is observed.
Despite a progressive increase in ED activity and older people, we have observed a decrease in hospital admissions in parallel with the Program of Care for Frailty development. Systematic application of similar programs in distinct EDs would have an impact on the overall health system.
KeywordsEmergency department Older people Geriatric assessment Delirium Frailty
The authors acknowledge the nurses, support staff, physicians, social workers, pharmacist and leadership at the Hospital de la Santa Creu i Sant Pau Emergency Department and other health providers in AIS Dreta; their enthusiastic efforts enabled the creation of a frailty program for patients to receive better urgent care. Collaborative network for urgent care in AIS Barcelona Dreta, partners: Mary Arjones, Maria Canela, Sergio Herrera, Héctor Hernández, J.Leopoldo Higa, Ana Juanes, Meritxell Liarte, Maria Antònia Mangues, Míriam Mateo, Mar Pina, Miguel Rizzi, Carme Rulló, Jordi Valls (Hospital de la Santa Creu I Sant Pau); Esther Pallarés, Àngels Cañas, Susana Subirà (Hospital Hestia Palau); Mª Luisa Giménez, Francisco López, Alicia Oses, Joan Solà (Nou Hospital Evangèlic); Dolors Quera, Neus Sáiz (Hospital Mutuam Güell); Pepa Romero (PADES, Grup Mutuam); Montse Espier, Rosa Planesas (Equips d’Atenció Residencial Grup Mutuam); Eulàlia Villegas, Ana García Sarasola, Mª Karuna Lamarca (Hospitalització a Domicili Dos de Maig), Mª Antònia Llauger (Atenció Primària Institut Català de la Salut).
All authors made substantial contributions to all of the following: concept and design of the study, acquisition of data, and analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the version to be submitted.
The research team won the 17th edition of the Fundació Mutuam Conviure Award (2017) for the best research project ‘Comprehensive geriatric assessment in ED, impact on patients’ health and flow management after implantation’ (6000-euro grant) which is still in progress and has helped to finance the translation and manuscript revision. The Mutuam Conviure Foundation is a non-profit organization with a mission to encourage health and social assistance for the elderly. The Mutuam Conviure Foundation Research Awards promote research or clinical practice improvement projects in the field of clinical gerontology and socio-sanitary care.
Compliance with ethical standards
Conflict of interest
The authors state that there is no conflict of interest and that no commercial, financial, and other relationships exist. This project received the Leadership and Management Award from La Unió Catalana d’Hospitals 2017 and was a finalist for the Excellence Award for Leadership and Management in Healthcare of the International Hospital Federation 2017.
In this article, patient data do not appear. The clinical research ethics committee of reference (Ethics Committee Sant Pau Biomedical Research Institute, IIB Sant Pau, Barcelona) approved this study (IIBSP-AGI-2017-14).
For this type of study informed consent is not required.
- 3.Cooke M, Oliver D, Burns a. Quality Care for older people with urgent & emergency care needs silver Book. 2012;1–102. https://www.bgs.org.uk/resources/silver-book
- 12.Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE et al (2015) Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med 22(1):1–21CrossRefGoogle Scholar
- 19.O’Sullivan D, Brady N, Manning E, O’Shea E, O’Grady S, O’Regan N et al (2018) Validation of the 6-item cognitive impairment test and the 4AT test for combined delirium and dementia screening in older emergency department attendees. Age Ageing 47:61–8Google Scholar
- 27.Age UK (2018) Intermediate care and reablement. Factsheet 76:1–10. https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs76_intermediate_care_and_reablement_fcs.pdf
- 28.Dahl U, Steinsbekk A, Johnsen R (2015) Effectiveness of an intermediate care hospital on readmissions, mortality, activities of daily living and use of health care services among hospitalized adults aged 60 years and older—a controlled observational study. BMC Health Serv Res 15(1):351CrossRefGoogle Scholar