scholarly journals The Ability of Frailty to Predict Outcomes in Older People Attending an Acute Medical Unit

2013 ◽  
Vol 12 (2) ◽  
pp. 74-76
Author(s):  
Simon Conroy ◽  
◽  
Teresa Dowsing ◽  
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Odds Ratio ◽  
Canadian Study ◽  
Clinical Frailty Scale ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Frailty Assessment

Background: This study assessed the role of frailty assessment in the AMU. Methods: Patients were assessed for frailty and their outcomes ascertained at 90 days. Results: The Canadian Study on Health and Aging Clinical Frailty Scale categorised 29% of patients as moderately-severely frail. Frailty did not differentially identify those likely to be discharged within one day, nor with long stays. Mortality at 90 days was 32%; frailty was associated with the risk of dying, odds ratio 1.4. 21% of patients were readmitted at 30 days, and 33% at 90 days, but frailty was not predictive. Discussion: Moderate-severe frailty in people aged 70+ was common and was predictive of higher mortality, but did not appear to predict admission, length of stay or readmission.

scholarly journals 334 GEMS: Geriatric Emergency Service - Rockwood’s Clinical Frailty Scale and Outcomes

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Danielle Reddy ◽  
Grainne Gallagher ◽  
Maureen O'Callaghan ◽  
Lorna Cornally ◽  
Megan Hayes Brennan ◽  
...  
Keyword(s):  
Older Adults ◽  
Length Of Stay ◽  
Older People ◽  
Patient Experience ◽  
Emergency Service ◽  
Strong Predictor ◽  
Canadian Study ◽  
Clinical Frailty Scale ◽  
Care Outcomes

Abstract Background Rockwood’s Clinical Frailty Scale (CFS), which uses clinical descriptors and pictographs, was developed to provide clinicians with an easily applicable tool to stratify older adults according to level of vulnerability. The CFS was validated in a sample of 2305 older participants from the Canadian Study of Health and Aging and was shown to be a strong predictor of institutionalisation and mortality (Rockwood K, 2005). Methods The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. At the end of CGA all patients have a score 1 to 9 assigned from the Clinical Frailty Scale (CFS). Results 10,037 patients were triaged in the first two years of the service. 43% screened positive for Frailty. 66% had a CGA. 10% were vulnerable CFS 4, 32% mildly frail CFS 5, 32% moderately frail CFS 6 and 31% severely frail CFS 7. Increasing score on the CFS correlated with increased length of stay, death and institutionalisation. Conclusion The CFS correlates with Length of stay (LOS), mortality and institutionalisation in people aged 75 years and older who attend as an emegency and screen positive for Frailty.

Socialising Disease: Medical Categories and Inclusion of the Aged

2000 ◽  
Vol 48 (3) ◽  
pp. 383-407 ◽  
Author(s):  
Joanna Latimer
Keyword(s):  
Older People ◽  
Hospital Care ◽  
Social Inclusion ◽  
Social Problems ◽  
Older Person ◽  
Medical Unit ◽  
Life Chances ◽  
Acute Medical Unit ◽  
Medical Domain

When older peoples' troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over-socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as ‘social problems'. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.

The effect of context on performance of an acute medical unit: experience from an Australian tertiary hospital

2012 ◽  
Vol 36 (3) ◽  
pp. 320 ◽  
Author(s):  
Belinda Suthers ◽  
Robert Pickles ◽  
Michael Boyle ◽  
Kichu Nair ◽  
Justyn Cook ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Local Context ◽  
Health Staff ◽  
Medical Unit ◽  
Acute Medical Unit ◽  
Transfers Of Care

Objective. To ascertain the improvements in length of stay and discharge rates following the opening of an acute medical unit (AMU). Methods. Retrospective cohort study of all patients admitted under general medicine from June–November 2008. Main outcome measures were length of stay in hospital and in the emergency department (ED). Results. The length of time spent in the emergency department for those admitted to the AMU was significantly shorter than those admitted directly to a medical ward (6.83 h v. 9.40 h, P < 0.0001). A trend towards shorter hospital length of stay continued after the AMU opened compared with the same period in the previous year (5.15 days (2.49, 11.57 CI) v. 5.66 days (2.76, 11.52 CI)). However, the number of ward transfers for a patient and the need to wait for a nursing home bed or public rehabilitation affected length of stay much more than the AMU. Conclusion. An AMU was successful in decreasing ED length of stay and contributed to decreasing hospital length of stay. However, we suggest that local context is crucially important in tailoring an AMU to obtain maximal benefit, and that AMUs are not a ‘one size fits all’ solution. What is known about the topic? Acute Medical Units were pioneered in the UK and have been shown to decrease length of stay with no increase in adverse events. As a result, they have been enthusiastically adopted in Australia. However, most studies have been single point ‘before/after’ designs looking at all medical patients, and there has been little consideration of the context in which AMUs operate and how this might affect their performance. What does this paper add? We consider length of stay trends over many years and separate single organ disease from multi-system disease patients, in order to ensure that gains are not simply a result of selective entry of healthier patients into AMUs. We also show that the effect of an AMU is small compared with other systemic issues, such as waiting for nursing home placement and the number of transfers of care. What are the implications for practitioners? Although there may be gains in terms of length of stay in the emergency department, those considering the establishment of an AMU need to consider other factors that may mitigate the improvements in hospital length of stay, such as the roadblocks to discharge, the organisation of allied health staff, and the number of transfers of care.

scholarly journals 259ASSOCIATION BETWEEN FRAILITY, LENGTH OF STAY AND DISCHARGE DESTINATION IN THE ACUTE MEDICAL UNIT

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii13.127-ii56
Author(s):  
Shane Toolan ◽  
Marie Therese Cooney ◽  
Orla Collins
Keyword(s):  
Length Of Stay ◽  
Discharge Destination ◽  
Medical Unit ◽  
Acute Medical Unit

The role of specialist respiratory input in a busy acute medical unit: Implications for diagnosis, management and discharge

2015 ◽  
Author(s):  
Akhtar Ali Akhtar ◽  
Sharon Dunning ◽  
Muhammad Hussain ◽  
Mohammad Ali ◽  
Muhammad Malik
Keyword(s):  
Medical Unit ◽  
Acute Medical Unit

scholarly journals 272 Clinical Audit on Transient Ischaemic Attack Investigations in Acute Medical Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Sylvia Karpinski ◽  
Orla Collins ◽  
Emer Kelly ◽  
Mary Therese Cooney ◽  
Emett McGrath
Keyword(s):  
Length Of Stay ◽  
Waiting Time ◽  
Transient Ischaemic Attack ◽  
Average Length ◽  
Medical Unit ◽  
Average Length Of Stay ◽  
Acute Medical Unit ◽  
Heart Monitoring ◽  
Retrospective Audit ◽  
Ischaemic Attack

Abstract Background TIA (Transient Ischaemic Attack) is a transient episode of neurologic dysfunction. Patients with a TIA have a high early risk of recurrent stroke. These patients need urgent initial evaluation with brain imaging, neurovascular imaging and cardiac evaluation. We conducted retrospective audit in our Acute Medical Unit (AMU) to assess waiting time and type of investigations completed as per TIA guidelines Methods All consecutive admissions with suspected TIAs were evaluated on length of stay, type of imaging tests obtained and how long they awaited for these tests. This was assessed by reviewing discharge summaries, and times and dates of scans on hospital imaging system. Results There was a total of 28 patients admitted to AMU with suspected TIA’s. Of these, 16 were female and 12 were male. Mean age was 70. All patients had CT brain done on admission, two out of 28 had to wait more than 12 hours. 25 out of 28 (89%) patients got US Carotid Dopplers, and two had CT intracranial angiograms. Average waiting time for US Carotid Dopplers was 33 hours, shortest wait was 6 hours and longest was 72 hours. 14 out of 24 (58%) had inpatient heart monitoring (24h telemetry or 24h Holter) two were excluded with known atrial fibrillation, one had PPM in situ and one refused monitoring. Average length of stay in AMU was 3 days. Conclusion Patients admitted to AMU with suspected TIAs had relevant imaging and tests completed as per guidelines. 89 % had US Carotid Dopplers which were on average done 33h from admission. 58% of patients had inpatient heart monitoring. The average length of stay was 3 days but three patients stayed in AMU for up to 5 days. Protected imaging slots for AMU would expedite investigations and reduce inpatient stay.

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