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Background: In recent years Lincoln County Hospital (LCH) has experienced a 7% annual rise in frail older adults attending the emergency department and conversion of these attendances to admissions has been around 80% causing considerable bed pressures on the service.

Colleagues in Leicester demonstrated (Conroy, Carver, Johnston et al, Age & Ageing 2010; 39 (S2), ii40) that a unit in the emergency department, specifically configured to provide services to frail older adults, can significantly decrease admissions. In LCH, a much smaller unit, this solution was thought unlikely to be cost-effective.

Innovation: An in-reach service into the medical emergency assessment unit (MEAU) was developed with the provision of a clinical nurse specialist and a geriatrician. The aim was to provide a rapid comprehensive geriatric assessment by coordinating their efforts with other health care professionals already working in the MEAU to form a virtual frailty unit. Referrals to the new service were made by nursing and medical staff working in MEAU. The objectives were to increase early discharges and to decrease length of stay.

Evaluation: During the12-week prospective evaluation 587 patients were referred to the service. Time constraints allowed review of only 55% of referrals. The outcomes for this group were compared to the outcomes of the group of referred patients who were not reviewed. Statistically, the two groups were not demographically different.

The percentage of discharges in the first two days was 31% for the intervention group and 16% for the comparison group.

The mean length of hospital stay of the intervention group was 10.3 days compared with 13.7 days in the comparison group.

If the cost of the intervention is the in-reach team's salaried hours then the cost of saving a bed day was £9.10p.

Conclusions: The in-reach service is both effective and cost-effective.

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