Seeking a social disposition for the medical patient: CAAST, a simple and objective clinical index

An index for the rapid and simple identification on admission of patients at high risk of becoming disposition problems was developed based on the patient's status of Continence, Ambulation, Age, Social Background, and Thought Processes (CAAST). One hundred seven consecutive admissions to City Hospital Center at Elmhurst were evaluated on admission according to the CAAST index and followed until discharge. The time that the patients remained in the hospital after their medical problems had been cared for was defined as social stay and was correlated with CAAST score. The high CAAST groups were found to have significantly increased mortality and longer average social stays with almost 40 per cent of their in-hospital time spent awaiting disposition. A high CAAST score should alert the physician to seek earlier help from social service in achieving a more rapid and more appropriate disposition for his or her patient.