41FRAILTY IN THE EMERGENCY DEPARTMENT: ARE BED ALLOCATION PRESSURES PRIORITISED OVER PATIENT FRAILTY IN THE ALLOCATION OF GERIATRIC BEDS?

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Abstract

Background: Clear frailty criteria are rarely used in assessing elderly patients for admission to geriatric wards from the Emergency Department (ED). This means frailty may often be a secondary consideration in an allocation system where time pressures and bed occupation pressures are paramount. These pressures particularly apply to elderly patients (Mason, S., Weber, E.J., Coster, J. (2012) Annals of Emergency Medicine 59 (5) pp.341-349). We aimed to evaluate whether, given these pressures, frail patients are being triaged appropriately to geriatric wards in our university teaching hospital.

Sampling methods: We sampled all 118 patients over 75 admitted from ED to geriatric and non-geriatric medical wards on weekdays over two-weeks. Patients with greater subspecialty needs were excluded i.e. Intensive / Intermediate / Coronary Care Units, Infectious Diseases.

Patients were evaluated using four well-validated frailty scales i.e. Clinical Frailty Scale (CFS) (Rockwood, K., Song, X., MacKnight, C., Canadian Medical Association Journal (2005) 173, pp.489-495), reported Edmonton Frailty Scale (rEFS) (Hilmer, S.N., Perera, V., Mitchell, S.,Australasian Journal on Ageing (2009) 28(4) pp.182-188), PRISMA-7 (Raiche, M., Hebert, R., Dubois, M-F (2008) Archives of Gerontology and Geriatrics, 47(1) pp.9-18), Identification of Seniors at Risk (ISAR) (Dendukuri, N., McCusker, J., Belzile, E.(2004)Journal of the American Geriatrics Society 52(2) pp.290-296). We then compared whether there was significantly increased frailty in the geriatric ward population, using the student t-test.

Results: Using each tool, distribution of frailty is similar between geriatric and non-geriatric wards.

Conclusions: The results suggest that patient frailty is not driving bed allocation in geriatric wards. Instead, it is likely that other factors are prioritised in the bed allocation process. Introduction of clear frailty criteria at ED may improve the prioritisation of frailty in geriatric bed allocation.

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