Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial
To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation. This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity...
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| Veröffentlicht in: | BMC geriatrics 2014-08, Vol.14 (1), p.98-98, Article 98 |
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| creator | Foo, Chik Loon Siu, Vivan Wing Yin Ang, Hou Phuah, Madeline Wei Ling Ooi, Chee Kheong |
| description | To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation.
This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months.
There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p |
| doi_str_mv | 10.1186/1471-2318-14-98 |
| format | Article |
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This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months.
There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p < 0.01). 82.9% of the intervention group had unmet needs; 62.1% accepted our interventions. Common positive findings were fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p < 0.01; IADL -2.57 vs +0.45, p < 0.01) at 12 months. The reduction in ED reattendance (OR0.75, CI 0.55-1.03, p = 0.07) and hospitalization (OR0.77, CI0.57-1.04, p = 0.09) were not significant, however the real difference would have been wider as 21.2% of the control group received geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis.
Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months.
National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.</description><identifier>ISSN: 1471-2318</identifier><identifier>EISSN: 1471-2318</identifier><identifier>DOI: 10.1186/1471-2318-14-98</identifier><identifier>PMID: 25178312</identifier><language>eng</language><publisher>England: BioMed Central</publisher><subject>Aged ; Aged, 80 and over ; Electronic health records ; Emergency medical care ; Emergency Service, Hospital - standards ; Female ; Follow-Up Studies ; Geriatric Assessment - methods ; Geriatrics ; Hospitalization ; Hospitals ; Humans ; Male ; Mass Screening - methods ; Mass Screening - standards ; Medical records ; Older people ; Patient satisfaction ; Risk Management - methods ; Risk Management - standards ; Time Factors</subject><ispartof>BMC geriatrics, 2014-08, Vol.14 (1), p.98-98, Article 98</ispartof><rights>2014 Foo et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Foo et al.; licensee BioMed Central Ltd. 2014 Foo et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b513t-5f6f3125c7ab88a01a2b28b15f99107634c8d1720387563d29ba04934b31d39b3</citedby><cites>FETCH-LOGICAL-b513t-5f6f3125c7ab88a01a2b28b15f99107634c8d1720387563d29ba04934b31d39b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161268/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161268/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25178312$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Foo, Chik Loon</creatorcontrib><creatorcontrib>Siu, Vivan Wing Yin</creatorcontrib><creatorcontrib>Ang, Hou</creatorcontrib><creatorcontrib>Phuah, Madeline Wei Ling</creatorcontrib><creatorcontrib>Ooi, Chee Kheong</creatorcontrib><title>Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial</title><title>BMC geriatrics</title><addtitle>BMC Geriatr</addtitle><description>To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation.
This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months.
There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p < 0.01). 82.9% of the intervention group had unmet needs; 62.1% accepted our interventions. Common positive findings were fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p < 0.01; IADL -2.57 vs +0.45, p < 0.01) at 12 months. The reduction in ED reattendance (OR0.75, CI 0.55-1.03, p = 0.07) and hospitalization (OR0.77, CI0.57-1.04, p = 0.09) were not significant, however the real difference would have been wider as 21.2% of the control group received geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis.
Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months.
National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Electronic health records</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - standards</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatrics</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - standards</subject><subject>Medical records</subject><subject>Older people</subject><subject>Patient satisfaction</subject><subject>Risk Management - methods</subject><subject>Risk Management - standards</subject><subject>Time Factors</subject><issn>1471-2318</issn><issn>1471-2318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFks1rHSEUxaW0NJ_r7IrQTTbTeHXG0U0gDU1bCBRCuhZ1nBfTGX3RmUL--zh96SMJKd3owfvjcDxchI6AfAIQ_ATqFirKQFRQV1K8Qbvbl7dP9A7ay_mWEGgF5e_RDm2KYkB3Ubry-RfOU9KT770tZwxYhw4nvfYdXrnk9ZS8xdkm54IPK-wXALvRpZUL9h53bq3TNLow4QprfDfr7KtUPOLos-uwjWFKcRiKLE56OEDvej1kd_h476OfF1-uz79Vlz--fj8_u6xMA2yqmp73JWJjW22E0AQ0NVQYaHopgbSc1VZ00FLCRNtw1lFpNKklqw2DjknD9tHpxnc9m9F1tgRMelDr5Eed7lXUXj2fBH-jVvG3qoED5aIYfN4YGB__YfB8YuOols7V0nlRSi4mx48pUrybXZ5UacW6YdDBxTkr4JQSztry5_-iDQfJJeG8oB9foLdxTqHU-YdaQEoLdbKhbIo5J9dvswNRy_68kvbD0862_N-FYQ_Rd8E4</recordid><startdate>20140830</startdate><enddate>20140830</enddate><creator>Foo, Chik Loon</creator><creator>Siu, Vivan Wing Yin</creator><creator>Ang, Hou</creator><creator>Phuah, Madeline Wei Ling</creator><creator>Ooi, Chee Kheong</creator><general>BioMed Central</general><general>BioMed Central Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>5PM</scope></search><sort><creationdate>20140830</creationdate><title>Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial</title><author>Foo, Chik Loon ; 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This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months.
There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p < 0.01). 82.9% of the intervention group had unmet needs; 62.1% accepted our interventions. Common positive findings were fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p < 0.01; IADL -2.57 vs +0.45, p < 0.01) at 12 months. The reduction in ED reattendance (OR0.75, CI 0.55-1.03, p = 0.07) and hospitalization (OR0.77, CI0.57-1.04, p = 0.09) were not significant, however the real difference would have been wider as 21.2% of the control group received geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis.
Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months.
National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.</abstract><cop>England</cop><pub>BioMed Central</pub><pmid>25178312</pmid><doi>10.1186/1471-2318-14-98</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Aged Aged, 80 and over Electronic health records Emergency medical care Emergency Service, Hospital - standards Female Follow-Up Studies Geriatric Assessment - methods Geriatrics Hospitalization Hospitals Humans Male Mass Screening - methods Mass Screening - standards Medical records Older people Patient satisfaction Risk Management - methods Risk Management - standards Time Factors |
| title | Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial |
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