P-037: Retrospective cohort study of effects of early geriatrician input for older persons from residential care presenting to emergency department: the REACH trial

摘要

Introduction: Residential aged care facility (RACF) residents are more likely to have a long stay in emergency departments (ED), with 84% more than 4 h [1]. RACF residents are more likely to experience delirium [2]. The aim of our study was to assess the effect of the Geriatrician lead REACH (Residential care, Emergency Department, Assessment and Management, Consumer centered, Hospital substitution) program on changing the hospitalisation trajectory for patients from RACF. Geriatricians reviewed emergency presentations of RACF residents who were referred for medical admission and provided followed up on discharge. Method: Retrospective review of data collected as part of the REACH trial. Data collected included demographics, triage category, Supportive and Palliative Care Indicators Tool (SPICT), 4AT and discharge destination, readmissions, representations and mortality. Results: There were 120 patients in the cohort with average age of 88 (81-92). 45% of patients were triaged as category 3. Cognitive impairment was present in 78% as measured by 4AT. The SPICT was positive in 81% of assessed patients. Cognitively impaired patients were more likely to have a positive SPICT (85 vs 15%, p 0.007). 67% were discharged back to RACF without admission and of those 39% received community geriatrician review.9 patients were readmitted within 90 days (7.5%) and 28 re-presented to ED within 90 days (23%). Of those, 84% were for unrelated reasons. There was no significant difference in 12 month mortality between those admitted versus discharged. Conclusion: REACH program successfully changed the trajectory of RACF residents without worsening mortality.