1906 Identifying Older Frail Patients Suitable for Same Day Emergency Care (SDEC); The Applicability of Patient Selection Scoring System

Abstract

Abstract Aim Several patient selection scores have been developed to identify patients suitable for SDEC from triage in Emergency Departments (ED) and the acute medical intake. Scores are designed to improve system efficiency, overcrowding and patient experience. Studies have been conducted that compare these; none in frail older adults. This study compared the Glasgow Admission Prediction Score (GAPS), Sydney Triage to Admission Risk Tool (START) and the Ambulatory Score (Amb). Methods The Older Person’s Assessment service is ED based, accepting patients with frailty syndromes aged >70 years with same-day discharge for >75% of patients. The OPAS databank was retrospectively analysed from June 2020 to December 2021. Interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside each ambulatory score. ED documentation was used to gain triage data. Results 748 attendances, 274(36.6%) Male with mean age 82.8(±8.5) years, CFS 5.2(±1.4) and CCI 6.7(±2.6) with 584(78.1%) discharged same day. Mean Amb score 4.2(±1.7), GAPS 21.4(±5.8), START 23.5(±4.7) all within admission range with 29.1% Mortality within 12 months. There was a significant difference between those admitted and discharged with CFS (p<0.001), mortality (p<0.001), Amb score and START score but not GAPS (p<0.001 vs p=0.03 vs p=0.17). Conclusion Frailty is an important determinant in identifying whether ambulatory care is appropriate. No score could be reliably used as a screen for suitable patients for SDEC services although the Amb score was the most accurate when assessing each individual variable. We are developing our own SDEC score for older, frailer adults which is currently being validated in the OPAS and SDEC settings.