title: Geriatric consultation service in emergency department: how does it work?
abstract: BACKGROUND
  Hong Kong is having a significant prevalence of geriatric patients who usually require admission after presentation to the hospital through emergency departments. The geriatric consultation programme 'We Care' aims at lowering acute geriatric medical admission.
  
  
  OBJECTIVE
  The study aims at analysing the impact of the geriatric consultation service on the acute medical admission, and to study the characteristics and outcome of geriatric patients.
  
  
  METHODS
  Retrospective study. Patients who received geriatric consultations during 1 January 2009 to 1 March 2011 were enrolled. The demographic information, diseases case mix, venue of discharge, clinical severity, community nursing service referrals and adverse outcomes were retrieved and analysed. The incidence of adverse outcomes under the presence of each factor was studied.
  
  
  RESULTS
  2202 geriatric patients were referred. Their age ranged from 45 to 99 (mean 79.91, SD 7.45, median 80). These cases were categorised into: (1) chronic pulmonary disease (n=673; 30.6%), (2) debilitating cardiac disease (n=526; 23.9%), (3) geriatric syndromes (n=147; 6.7%), (4) neurological problems (n=416; 18.9%), (5) diabetes-related problems (n=146; 6.6%), (6) terminal malignancy (n=39; 1.8%), (7) electrolyte or input/output disturbance (n=137; 6.2%), (8) non-respiratory infections (n=36, 1.6%) and (9) others (n=82; 3.7%). Acute medical admission was evaded in 84.7% of all consultations with 1039 (47.2%) patients discharged home and 825 patients (37.5%) admitted to convalescent hospital. The incidence rate of adverse outcomes was 1.6%.
  
  
  CONCLUSIONS
  Programme 'We Care' provided comprehensive geriatric assessment to suitable geriatric patients, resulting in an effective reduction of acute geriatric hospital admission.
authors.affiliation: Accident and Emergency Department, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong SAR, China. dr_myyuen@yahoo.com.hk
authors.forename: Terry Man Yue
authors.initials: TM
authors.lastname: Yuen
authors.forename: Larry Lap Yip
authors.initials: LL
authors.lastname: Lee
authors.forename: Ikea Lai Chun
authors.initials: IL
authors.lastname: Or
authors.forename: Kwai Lin
authors.initials: KL
authors.lastname: Yeung
authors.forename: Jimmy Tak Shing
authors.initials: JT
authors.lastname: Chan
authors.forename: Catherine Pui Yuk
authors.initials: CP
authors.lastname: Chui
authors.forename: Emily Wai Lin
authors.initials: EW
authors.lastname: Kun
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies