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dc.contributor.authorRomero-Ortuno, Romanen
dc.contributor.authorBriggs, Roberten
dc.contributor.authorCunningham, Conalen
dc.date.accessioned2020-11-24T13:27:53Z
dc.date.available2020-11-24T13:27:53Z
dc.date.issued2020en
dc.date.submitted2020en
dc.identifier.citationÍde 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, Conal Cunningham, Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department, European Journal of Internal Medicine, 2020en
dc.identifier.otherYen
dc.identifier.urihttp://hdl.handle.net/2262/94181
dc.descriptionPUBLISHEDen
dc.description.abstractBackground: Older 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. Aim: To evaluate if routinely collected CGA metrics were associated with ED disposition outcomes. Design: Retrospective observational study. Methods: We 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. Results: In 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. Conclusions: Routinely 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.en
dc.language.isoenen
dc.relation.ispartofseriesEuropean Journal of Internal Medicineen
dc.rightsYen
dc.subjectEmergency Departmenten
dc.subjectOlder peopleen
dc.subjectFrailtyen
dc.subjectIllness Acuityen
dc.subjectDeliriumen
dc.titleHome FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Departmenten
dc.typeJournal Articleen
dc.type.supercollectionscholarly_publicationsen
dc.type.supercollectionrefereed_publicationsen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/romerooren
dc.identifier.peoplefinderurlhttp://people.tcd.ie/cunnincjen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/rbriggsen
dc.identifier.rssinternalid221418en
dc.identifier.doihttps://doi.org/10.1016/j.ejim.2020.11.015en
dc.rights.ecaccessrightsopenAccess
dc.subject.TCDThemeAgeingen
dc.identifier.orcid_id0000-0002-3882-7447en
dc.subject.darat_impairmentAge-related disabilityen
dc.subject.darat_impairmentChronic Health Conditionen
dc.subject.darat_thematicHealthen
dc.status.accessibleNen


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