NDLI: Factors associated with admission to bed-based care: observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)

Content Provider	Springer Nature : BioMed Central
Author	Elias, Tania C. N. Bowen, Jordan Hassanzadeh, Royah Lasserson, Daniel S. Pendlebury, Sarah T.
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%) 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.
Related Links	https://bmcgeriatr.biomedcentral.com/counter/pdf/10.1186/s12877-020-01942-9.pdf
Ending Page	13
Page Count	13
Starting Page	1
File Format	HTM / HTML
ISSN	14712318
DOI	10.1186/s12877-020-01942-9
Journal	BMC Geriatrics
Issue Number	1
Volume Number	21
Language	English
Publisher	BioMed Central
Publisher Date	2021-01-06
Access Restriction	Open
Subject Keyword	Geriatrics Gerontology Aging Rehabilitation Same day emergency care Ambulatory care Predictive factors Hospital admission Bed-based care Frailty Delirium Multi-morbidity Geriatrics/Gerontology
Content Type	Text
Resource Type	Article
Subject	Geriatrics and Gerontology
Journal Impact Factor	3.4/2023
5-Year Journal Impact Factor	4.1/2023

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