109CAN A FRAILTY SCALE BE USED TO TRIAGE ELDERLY PATIENTS FROM EMERGENCY DEPARTMENT TO GERIATRIC WARDS?

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Abstract

Background: There is no widely established method for triaging elderly, frail patients to geriatric wards. In our teaching hospital, informal methods are currently used to allocate patients. We aimed to assess the potential impact of introducing the Clinical Frailty Scale (CFS) (Rockwood, K., Song, X., MacKnight, C., Canadian Medical Association Journal (2005) 173, pp.489-495) as a triaging method for patients aged over 75 who are admitted via the Emergency Department (ED). The CFS is a rapid, simple case-finding tool which might be used to improve the proportion of frail patients who are identified and allocated to geriatric wards.

Methods: We applied the Clinical Frailty Scale to 118 elderly patients who had been admitted from ED over a two-week period. We compared the distribution of frailty in geriatric and non-geriatric wards, and measured the strength of the CFS to identify frail people, compared to other frailty scales i.e. reported Edmonton Frailty Scale (rEFS) (Hilmer, S.N., Perera, V., Mitchell, S., Australasian Journal on Ageing (2009) 28(4) pp.182-188, PRISMA-7, Identification of Seniors at Risk (ISAR) (Dendukuri, N., McCusker, J., Belzile, E. Journal of the American Geriatrics Society (2004) 52(2) pp.290-296).

Results: The current difference between frailty in geriatric and non-geriatric medical wards in patients aged over 75 was not statistically significant (Standard deviation = 1.84 (geriatric), 2.10 (non-geriatric, p = 0.58).Analysis of receiver operating curves showed that the Clinical Frailty Scale accurately identified frail patients when compared to other well-validated frailty scales at appropriate cut-off points (rEFS = 9 + , Area under curve (AUC) = 89.1%, standard deviation (SD) = 3%) (ISAR = 3 + , AUC = 81.7%, SD = 3.9%) (PRISMA-7 = 2 + , AUC = 90.8%, SD = 3.1%).

Conclusions: Implementation of the CFS as a triage tool for elderly patients at ED could increase the proportion of frail patients who are directly admitted to a geriatric ward. This could improve patient access to appropriate geriatric care.

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