103 Impact of dedicated consultant geriatrician involvement on direct discharge of frail patients from the emergency department (ED): a pilot study

Abstract

Abstract Background Timely assessment and tailored intervention by a dedicated multi-disciplinary Frailty Intervention Therapy Team (FITT) in ED helps facilitate direct discharge from ED of frail older people who may otherwise be admitted. We assessed the impact of additional consultant geriatrician involvement on safe admission avoidance in suitable older patients. Methods A consultant geriatrician, registrar and an ANP worked in conjunction with FITT, ED colleagues, and teams on call. This pilot service ran 9 am-5 pm Tuesdays to Thursdays. All patients >75y in the ED were recorded and discussed at regular huddles. Frail patients at high risk for admission had consultant geriatrician review, to facilitate discharge where possible. Results We completed 27 days over a 9-week period, with both registrar and ANP present on 17/27 (63%) days. 315 patients were discussed. Commonest reasons for presentation included falls (57%), generally unwell (15%) and abdominal pain (12%). Of those actively reviewed (165), 116 were discharged (70.3%; 4.3 patients daily). Mean age was 76y (75–101), 44% were > 80y and 71% were female. CFS was 5–8 in 64%. Most came from home (68%) or nursing home (29%). Rapid follow-up was arranged for outpatient/day hospital (38;33%), NH outreach (18;16%), ICPOP (8; 7%), falls/fracture clinics (6;5%), community allied professionals (4;3%) and Palliative services (2;1.7%). Of those discharged, 11 returned to ED within four weeks (9.5% return rate). Conclusion Geriatrician input with FITT and ANP services in ED efficiently facilitated additional daily discharges of frail patients who were at high risk for unnecessary admission. With a mean of 4.3 discharges a day, a five day service should achieve 1,118 discharges a year. Allowing for a return rate of 9.5% and a mean length of stay of 14 days, such annual discharges would result in 14,168 bed days saved annually, well in excess of the annual bed-days activity on a 35 bed ward.