title: Embedding comprehensive geriatric assessment in the emergency assessment unit: the impact of the COPE zone.
abstract: We introduced a geographically embedded frailty unit, the comprehensive older person's evaluation 'COPE' zone within our emergency assessment unit (EAU). We collated data for all medical patients over 75 years admitted non-electively for one month before and after this service change. Significantly more patients were seen by a geriatrician on the EAU earlier in their admission in 2014 (33.4 vs 19.3%, p<0.001; 11 vs 20 h, p<0.001). More patients had documented comprehensive geriatric assessment and discussion in a geriatrician multidisciplinary team meeting (relative risk (RR) 3.3, 95% confidence interval (CI) 2.35-4.73, p<0.001; RR 3.6, 95% CI 2.26-5.57, p<0.001, respectively). More patients with markers of frailty were discharged directly from EAU (42.2 vs 29.0%, p = 0.006) without increasing readmissions. Mean length of stay was reduced (9.5 vs 6.8 days, p = 0.02). The introduction of the COPE zone has improved service delivery at the point of access for older people admitted to hospital.
authors.affiliation: Department for Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK joanne.taylor111@gmail.com.
authors.forename: Joanne K
authors.initials: JK
authors.lastname: Taylor
authors.affiliation: Department of Acute Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Oliver S
authors.initials: OS
authors.lastname: Gaillemin
authors.affiliation: Department of Acute Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Pearl
authors.affiliation: Department for Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Murphy
authors.affiliation: Department for Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fox
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D010359:Patient Readmission; D012189:Retrospective Studies; D006113:United Kingdom
keywords: Frailty unit; acute medicine; comprehensive geriatric assessment; older people; readmissions
references.citation: Stroke. 2000 May;31(5):1038-45
references.pmid: 10797163
references.citation: J Am Geriatr Soc. 2004 May;52(5):675-84
references.pmid: 15086645
references.citation: Br Med Bull. 2005 Jan 31;71:45-59
references.pmid: 15684245
references.citation: Age Ageing. 2007 Nov;36(6):670-5
references.pmid: 17656421
references.citation: Age Ageing. 2008 Jul;37(4):416-22
references.pmid: 18487268
references.citation: BMJ. 2009 Jan 22;338:b50
references.pmid: 19164393
references.citation: Gerontologist. 2010 Aug;50(4):451-8
references.pmid: 20185522
references.citation: Br J Hosp Med (Lond). 2010 Feb;71(2):98-101
references.pmid: 20220698
references.citation: Clin Geriatr Med. 2011 Feb;27(1):1-15
references.pmid: 21093718
references.citation: Age Ageing. 2011 Jul;40(4):436-43
references.pmid: 21616954
references.citation: Cochrane Database Syst Rev. 2011 Jul 06;(7):CD006211
references.pmid: 21735403
references.citation: J Trauma. 2011 Nov;71(5):1390-4
references.pmid: 22002614
references.citation: J Am Geriatr Soc. 2011 Nov;59(11):2129-38
references.pmid: 22091630
references.citation: J Nutr Health Aging. 2012 Apr;16(4):313-8
references.pmid: 22499448
references.citation: J Gerontol A Biol Sci Med Sci. 2013 Jan;68(1):62-7
references.pmid: 22511289
references.citation: Emerg Med J. 2013 Sep;30(9):699-700
references.pmid: 23250895
references.citation: Age Ageing. 2013 Nov;42(6):776-81
references.pmid: 23666406
references.citation: Age Ageing. 2014 Jan;43(1):109-14
references.pmid: 23880143
references.citation: BMJ. 2013 Oct 08;347:f5874
references.pmid: 24103444
references.citation: Age Ageing. 2014 Jul;43(4):472-7
references.pmid: 24222658
references.citation: Clin Med (Lond). 2015 Aug;15(4):377-81
references.pmid: 26407391
references.citation: Lancet. 1993 Oct 23;342(8878):1032-6
references.pmid: 8105269