Abstract
Objectives
The EDIFY program was developed to deliver early geriatric specialist interventions
at the emergency department (ED) to reduce the number of acute admissions by identifying
patients for safe discharge or transfer to low-acuity care settings. We evaluated
the effectiveness of EDIFY in reducing potentially avoidable acute admissions.
Design
A quasi-experimental study.
Setting
ED of a 1700-bed tertiary hospital.
Participants
ED patients aged ≥85 years.
Measurements
We compared EDIFY interventions versus standard care. Patients with plans for acute
admission were screened and recruited. Data on demographics, premorbid function, frailty
status, comorbidities, and acute illness severity were gathered. We examined the primary
outcome of “successful acute admission avoidance” among the intervention group, which
was defined as no ED attendance within 72 hours of discharge from ED, no transfer
to an acute ward from subacute-care units (SCU) within 72-hours, or no transfer to
an acute ward from the short-stay unit (SSU). Secondary outcomes were rehospitalization,
ED re-attendance, institutionalization, functional decline, mortality, and frailty
transitions at 1, 3, and 6 months.
Results
We recruited 100 participants (mean age 90.0 ± 4.1 years, 66.0% women). There were
no differences in baseline characteristics between intervention (n = 43) and nonintervention
(n = 57) groups. Thirty-five (81.4%) participants in the intervention group successfully
avoided an acute admission (20.9% home, 23.3% SCU, and 44.2% SSU). All participants
in the nonintervention group were hospitalized. There were no differences in rehospitalization,
ED re-attendance, institutionalization and mortality over the study period. Additionally,
we observed a higher rate of progression to a poorer frailty category at all time
points among the nonintervention group (1, 3, and 6 months: all P < .05).
Conclusions and Implications
Results from our single-center study suggest that early geriatric specialist interventions
at the ED can reduce potentially avoidable acute admissions without escalating the
risk of rehospitalization, ED re-attendance, or mortality, and with possible benefit
in attenuating frailty progression.
Keywords
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Article info
Publication history
Published online: March 03, 2021
Footnotes
All authors declare no conflicts of interest.
This work was supported by the Ng Teng Fong Healthcare Innovation Programme (Project Code: NTF_JUL2017_I_C2_CQR_02), which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
