title: Effectiveness of a geriatrician in the emergency department in facilitating safe admission prevention of older patients.
abstract: The decision to admit a frail older patient is rarely made by a geriatrician and often falls to staff in the emergency department (ED), who may not have the training to balance the risks, benefits and alternatives. We based a consultant geriatrician in the ED with the primary aim of facilitating admission prevention for older patients and this was achieved for 64% (543/848) of patients. A secondary aim was to facilitate direct admission to elderly care wards when admission was necessary, and this was achieved for 57% of admitted patients (174/305). The geriatrician was able to facilitate discharge from the ED for over half of potential 30-day readmissions seen. The overall 7-day ED re-attendance rate was 10.1%, but only 3.4% of patients were admitted with the same problem, indicating true admission prevention rather than admission delay. In conclusion, the placement of a consultant geriatrician in the ED is effective in facilitating admission prevention for older patients.
authors.affiliation: Birmingham Heartlands Hospital, Heart of England Foundation Trust, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Jones
authors.forename: Peter
authors.initials: P
authors.lastname: Wallis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*
keywords: Geriatrician; admission prevention; emergency department; frail