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  • 171 The impact of frailty screening of older adults with multidisciplinary assessment of those at risk during emergency hospital attendance on the quality and safety of care (SOLAR): a randomised controlled trial

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171 The impact of frailty screening of older adults with multidisciplinary assessment of those at risk during emergency hospital attendance on the quality and safety of care (SOLAR): a randomised controlled trial
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  1. Aoife Leahy1,
  2. Louise Barry2,
  3. Gillian Corey1,
  4. Aoife Whiston1,
  5. Helen Purtill3,
  6. Denys Shchetkovskyy4,
  7. Damien Ryan4,
  8. Elaine Shanahan5,
  9. Margaret O’Connor5,
  10. Rose Galvin1
  1. 1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
  2. 2School of Nursing, University of Limerick, Ireland
  3. 3Department of Mathematics, University of Limerick, Ireland
  4. 4Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Ireland
  5. 5Department of Ageing and Therapeutics, University Hospital Limerick, Ireland
  6. *denotes presenting author

Abstract

Background Comprehensive multidisciplinary geriatric assessment (CGA) has been proven to improve outcomes in hospitalised older adults but there is limited evidence of its effectiveness in the Emergency Department (ED). We aim to assess the benefits of CGA in the ED for frail older adults.

Methods Older adults over 75 who presented with medical complaints and screened positive for frailty on the ISAR (>/=2) were randomised to geriatrician-led multidisciplinary comprehensive geriatric assessment and management or to usual care (randomisation allocation 1:1). The primary outcome was waiting time in the ED. Secondary outcomes were mortality, ED re-attendance, hospitalisation, nursing home admission, quality of life and functionality at 30 days and 180 days.

Results 228 patients were recruited with a mean age of 83.75. (113 in intervention group, 115 in Control group). There was a statistically significant improvement in ED waiting times in the intervention group (17.4 hours vs 21.1 hours p = 0.013). The intervention group had significantly lower rates of ED re-attendance, hospitalisation, nursing home admission and higher self-reported function as per Barthel score at 180 days but not 30 days. There was a statistically significant benefit in self-reported quality of life scores in the intervention group (EQ5D5L).

Conclusion Multidisciplinary assessment of older frail adults in the ED setting conferred a statistically significant improvement in ED waiting times at index visit and lower rates of ED re-attendance, nursing home admission, quality of life and function at 180 days. Further multi-centre trials are warranted to explore the external validity of the findings.

https://doi.org/10.1136/emermed-2023-IAEM.6

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