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The impact of frailty and geriatric syndromes on metrics of acute care performance : results of a national day of care survey
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Knight, T.., Atkin, C., Kamwa, T., Subbe, C., Holland, M., Sapey, E. and Lasserson, D. S. (2023) The impact of frailty and geriatric syndromes on metrics of acute care performance : results of a national day of care survey. EClinicalMedicine, 66 . 102278. doi:10.1016/j.eclinm.2023.102278 ISSN 2589-5370.
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Official URL: https://doi.org/10.1016/j.eclinm.2023.102278
Abstract
Background:
Frailty is associated with a range of adverse clinical outcomes in the acute hospital setting. We sought to determine whether frailty and related factors affected clinical processes such as time to assessment during emergency hospital admission within the National Health Service (NHS) in the UK.
Methods:
The Society for Acute Medicine Benchmarking Audit (SAMBA) is an annual cross-sectional day of care survey. SAMBA 2022 was conducted on Thursday 23rd June 2022. We assessed whether the Clinical Frailty Scale (CFS) and presence of a geriatric syndrome affected performance against nationally recognised clinical quality indicators based on time to initial assessment and time to consultant review . CFS was graded into robust (CFS1-3), mild (CFS 4-5), moderate (CFS 6), severe (CFS7-8) and terminal illness (CFS 9). Plausible values were created for missing variables using multi-level multiple imputation. The association was described using mixed effect generalised linear models adjusting for initial National Early Warning Score 2 (NEWS2) and time of arrival.
Findings:
A total of 152 hospitals provided patient level data relating to 7248 emergency medical admissions. Patients with mild, moderate and severe frailty were less likely to be assessed within four hours of arrival (adjusted OR, mild 79, 95%CI 0.68-0.96, moderate 0.67 95%CI 0.53-0.84, severe, 0.75 95%CI 0.58-0.96, terminally ill 0.59 95%CI 0.23-1.43) and less likely to be achieve the clinical quality indicator for consultant review (adjusted OR, mild 0.69 95%CI 0.58-0.83, moderate 0.55 95%CI 0.44-0.70, severe 0.54 95%CI 0.41-0.69, terminally ill 0.76 95% CI 0.42-1.5). Patients with geriatric syndromes were also less likely to be assessed within 4 hours of arrival (adjusted OR 0.66 95%CI 0.56-0.76) or by a consultant within the recommended time frame (adjusted OR 0.45 95%CI 0.39-0.51). The difference was partially explained by differential use of SDEC pathways.
Sub-group analysis of 5148 patients assessed outside of SDEC areas demonstrated patients with geriatric syndromes (adjusted OR 0.71, 95%CI 0.60-0.83), but not frailty defined by CFS were less likely to be assessed within 4 hours of arrival.
Moderate and severe frailty and the presence of a geriatric syndrome was associated with a decreased likelihood of achieving the consultant review standard (moderate, adjusted 0R 0.75, 95%CI 0.59-0.94, severe adjusted OR 0.75 95%CI 0.58-0.96, geriatric syndrome adjusted OR 0.59, 95%CI 0.50-0.69).
Interpretation:
Frailty is associated with delayed clinical assessment. This association may suggest a systemic issue with clinical prioritisation, with important implications for acute care policy.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RC Internal medicine | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Geriatrics, Older people -- Medical care, Frail older people, Older people -- Hospital care | |||||||||
Journal or Publication Title: | EClinicalMedicine | |||||||||
Publisher: | Elsevier | |||||||||
ISSN: | 2589-5370 | |||||||||
Official Date: | December 2023 | |||||||||
Dates: |
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Volume: | 66 | |||||||||
Article Number: | 102278 | |||||||||
DOI: | 10.1016/j.eclinm.2023.102278 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 27 October 2023 | |||||||||
Date of first compliant Open Access: | 9 November 2023 | |||||||||
RIOXX Funder/Project Grant: |
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