Decision tree for ward admissions of older patients at the emergency department after a fall

Abstract

The need for ward admission in older patients who access the ED after a fall seems to be determined not only by the severity of fall-related injuries, but also by the fall dynamics and the individual's clinical complexity. Geriatr Gerontol Int 2018; 18: 1388-1392.

A survey of OR/MS models on care planning for frail and elderly patients

“…Seven of the eight papers focused on a single hospital setting and the remaining paper focused on community care [13]. There were a further eight papers which focused on an inpatient department: an emergency department [62,64,65,70] or a geriatric ward [15,24,33,55]. Interestingly, none of these 16 papers used care planning across multiple settings.…”

“…Within the elderly population, there are many people who have multiple long-term conditions (MLTC), which may explain why there were many papers that focus on chronic conditions. Eleven papers focused on the acute care setting [1,8,25,48,59,64,65,66,67,70,76]. This is surprising given frail and elderly patients are more likely to suffer from acute conditions as a result from chronic illness.…”

“…Fourteen papers focused on making improvements to an aspect of the path-way. Five of these aimed to improve the flow of patients [14,36,64,67,70]. Only three papers had the primary focus on improving patient care [22,63,65].…”

Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study

“…Low-energy falls (LEF) occur in one-third of adults over the age of 65 each year and are a leading cause of death in developed nations [1]. The emergency department (ED) visit rates for LEF among older adults are increasing [2][3][4][5] with increasing odds for hospital admission [4,6,7] and significant morbidity and mortality that appear to increase with age [8][9][10]. Previous studies that exclusively focus on older adults with LEF in the ED report hospital admission rates between 40% [6] and 66% [11,12].…”

“…Therefore, an early and reliable prediction of hospital admission upon presentation to the ED of the older patient with LEF, reflecting both the acute fall-related injuries and the underlying acute and chronic health conditions, is required. This has been investigated by a few previous studies [6]. Besides validated instruments to measure frailty [14][15][16][17][18] or prognostic comorbidity [19,20], geriatric assessments, including patient-centered and reported outcome measures, might provide valid and valuable information on the quality of life, functionality, physical, mental and social health, and should directly support the disposition decision as well as surgical therapy [21][22][23][24].…”