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Factors associated with admission to bed-based care : observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)
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Bowen, Elias T., Hassanzadeh, R., Lasserson, Daniel and Pendlebury, S. T. (2021) Factors associated with admission to bed-based care : observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC). BMC Geriatrics, 21 . 8. doi:10.1186/s12877-020-01942-9 ISSN 1471-2318.
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Official URL: https://doi.org/10.1186/s12877-020-01942-9
Abstract
Background. The development of ambulatory emergency care services, now called ‘Same Day Emergency Care’ (SDEC) has been advocated to provide sustainable high quality healthcare in an ageing population. However, there are few data on SDEC and the factors associated with successful ambulatory care in frail older people. We therefore undertook a prospective observational study to determine i) the clinical characteristics and frailty burden of a cohort in an SDEC designed around the needs of older patients and ii) the factors associated with hospital admission within 30-days after initial assessment.
Methods. The study setting was the multidisciplinary Abingdon Emergency Medical Unit (EMU) located in a community hospital and led by a senior interface physician (geriatrician or general practitioner). Consecutive patients from August-December 2015 were assessed using a structured paper proforma including cognitive/delirium screen, comorbidities, functional, social, and nutritional status. Physiologic parameters were recorded. Illness severity was quantified using the Systemic Inflammatory Response Syndrome (SIRS>1). Factors associated with hospitalization within 30-days were determined using multivariable logistic regression.
Results. Among 533 patients (median (IQR) age=81 (68-87), 315 (59%) female), 453 (86%) were living at home but 283 (54%) required some form of care and 299 (56%) had Barthel<20. Falls, urinary incontinence and dementia affected 81/189 (43%), 50 (26%) and 40 (21%) 23 of those aged >85 years." Severe illness was present in 148 (28%) with broadly similar rates across age groups. Overall, 210 (39%) patients had a hospital admission within 30-days with higher rates in older patients: 96 (87%) of <65 years remained on an ambulatory pathway versus only 91 (48%) of >85 years (p<0.0001). Factors independently associated with hospital admission were severe illness (SIRS/point, OR=1.46,95% CI=1.15-1.87, p=0.002) and markers of frailty: delirium (OR=11.28,3.07-41.44,p<0.0001), increased care needs (OR=3.08,1.55-6.12,p=0.001), transport requirement (OR=1.92,1.13-3.27), and poor nutrition (OR=1.13-3.79,p=0.02).
Conclusions. Even in an SDEC with a multidisciplinary approach, rates of hospital admission in those with severe illness and frailty were high. Further studies are required to understand the key components of hospital bed-based care that need to be replicated by models delivering acute frailty care closer to home, and the feasibility, cost-effectiveness and patient/carer acceptability of such models.
Item Type: | Journal Article | ||||||||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RT Nursing |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Emergency medical services -- Great Britain, Emergency nursing -- Great Britain, Emergency medicine -- Great Britain, Ambulatory medical care, Hospitals -- Administration, Delirium, Frail elderly -- Care -- Great Britain, Comorbidity | ||||||||||||
Journal or Publication Title: | BMC Geriatrics | ||||||||||||
Publisher: | BioMed Central Ltd. | ||||||||||||
ISSN: | 1471-2318 | ||||||||||||
Official Date: | 6 January 2021 | ||||||||||||
Dates: |
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Volume: | 21 | ||||||||||||
Article Number: | 8 | ||||||||||||
DOI: | 10.1186/s12877-020-01942-9 | ||||||||||||
Status: | Peer Reviewed | ||||||||||||
Publication Status: | Published | ||||||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||||||
Date of first compliant deposit: | 4 December 2020 | ||||||||||||
Date of first compliant Open Access: | 10 March 2021 | ||||||||||||
RIOXX Funder/Project Grant: |
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