Authors: (including presenting author): :
Cheng HY(1), Cheng MK(1), Lai TL(1), Tsang WC(1), Wong KW(1), Kung SW(2), Yau KP(2), CHAN SM(2)
Affiliation: :
(1)Department of Medicine, Tseung Kwan O Hospital, (2)Accident and Emergency Department, Tseung Kwan O Hospital
Introduction: :
Elderly attends Accident and Emergency Department (AED) for various problems, and many were admitted into acute medical units for multidisciplinary care. In Tseung Kwan O Hospital (TKOH), the admission rate of patients aged ≥ 60 triaged category 3 and 4 was around 33%, compared with 6% in the younger counterparts. Worldwide, models with geriatrician involved at AED have shown effectiveness in minimizing the rate of hospitalization and reducing healthcare system burden. Thus, “Geriatrics Support at AED” was introduced in TKOH since winter surge 2018.
Objectives: :
To reduce admission into acute medical unit and ensure safe supported discharge through timely geriatric assessment to selected elderly patients in AED.
Methodology: :
From January to May 2018 and December 2018 to May 2019, patients aged ≥ 60 triaged category 3 and 4 were referred by AED specialists in EMW for geriatric team assessment. Multi-disciplinary care was provided if necessary. Fast-track geriatrics out-patient clinics were arranged. Post-discharge community support services e.g. Integrated Care and Discharge Support Program, Community Nursing Service, Geriatric Day Hospital were referred whenever appropriate. For winter surge 2020, the service was nurse-led without on-site geriatric consultation, started in December 2019 and terminated in late January due to COVID-19.
Result & Outcome: :
From 2018 to 2020, 502 patients were recruited. 328 (65.3%) were female, and the mean age was 82.8. 248 (49.4%) of them were vulnerable or mildly frail, with Clinical Frailty Scale 4-5. The commonest referral diagnosis was fall (32.1%), followed by musculoskeletal pain (17.5%), syncope/ vertigo (14.3%), poor blood pressure control (9.0%), hyper-/hypoglycemia (4.4%). 359 patients (71.5%) were discharged from hospital directly, while 62 (12.4%) were admitted to acute medical wards. 61 patients (12.2%) were transferred to convalescent units (TKOH/ Haven of Hope Hospital). Among those discharged directly, 51 patients (14.2%) re-attended AED within 28 days. There was zero mortality in 28 days. When comparing outcome of geriatric team versus nurse-led model, direct discharge rate was 74.2% versus 56.0%, re-attendance rate was 12.6% against 26.2%.
“Geriatrics Support at AED” offering geriatric team assessment at AED was effective in reducing hospitalization into acute medical unit in selected older patients.
