• Íde O'Shaughnessy, Roman Romero-Ortuno, Lucinda Edge, Aoife Dillon, Sinéad Flynn, Robert Briggs, Darragh Shields, Geraldine McMahon, Arthur Hennessy, Una Kennedy, Paul Staunton, Rosa McNamara, Suzanne Timmons, Frances Horgan, and Conal Cunningham.
• Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
• Eur. J. Intern. Med. 2021 Mar 1; 85: 50-55.

BackgroundOlder people in the Emergency Department (ED) are clinically heterogenous and some presentations may be better suited to alternative out-of-hospital pathways. A new interdisciplinary comprehensive geriatric assessment (CGA) team (Home FIRsT) was embedded in our acute hospital's ED in 2017.AimTo evaluate if routinely collected CGA metrics were associated with ED disposition outcomes.DesignRetrospective observational study.MethodsWe included all first patients seen by Home FIRsT between 7th May and 19th October 2018. Collected measures were sociodemographic, baseline frailty (Clinical Frailty Scale), major diagnostic categories, illness acuity (Manchester Triage Score) and cognitive impairment/delirium (4AT). Multivariate binary logistic regression models were computed to predict ED disposition outcomes: hospital admission; discharge to GP and/or community services; discharge to specialist geriatric outpatients; discharge to the Geriatric Day Hospital.ResultsIn the study period, there were 1,045 Home FIRsT assessments (mean age 80.1 years). For hospital admission, strong independent predictors were acute illness severity (OR 2.01, 95% CI 1.50-2.70, P<0.001) and 4AT (OR 1.26, 95% CI 1.13 - 1.42, P<0.001). Discharge to specialist outpatients (e.g. falls/bone health) was predicted by musculoskeletal/injuries/trauma presentations (OR 6.45, 95% CI 1.52 - 27.32, P=0.011). Discharge to the Geriatric Day Hospital was only predicted by frailty (OR 1.52, 95% CI 1.17 - 1.97, P=0.002). Age and sex were not predictive in any of the models.ConclusionsRoutinely collected CGA metrics are useful to predict ED disposition. The ability of baseline frailty to predict ED outcomes needs to be considered together with acute illness severity and delirium.Copyright © 2020. Published by Elsevier B.V.

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