[Effectiveness of reevaluation of admission of patients with poor functional status]

Acute care hospitals are one of the healthcare settings that pose the greatest risk of inefficiency and iatrogeny in the elderly. The term "inappropriate admission" refers to those admissions that could have been dealt with in an outpatient clinic or in a hospital with a lower level of care. We designed an intervention in the Emergency Department of our hospital (Hospital Universitario de Getafe, Madrid) with the aim of reducing the percentage of inappropriate admissions in the elderly.

A geriatrician reevaluated admissions of patients aged 75 years old and above, with established severe dependence in either of the two areas evaluated (physical and cognitive) and who were candidates for admission to the Acute Unit.

Of 380 patients who were reevaluated, 240 were discharged instead of being admitted. These patients were referred to different levels of care: 123 patients (51.25%) were monitored in the Community Care Unit, 12 (5%) were referred to other hospitals with a lower level of care (Palliative Unit and/or Long Term care Unit) and 8 patients (3.34%) were sent to the outpatient clinic. By avoiding 240 admissions, an estimated 1992 stays were prevented, representing a saving of 619, 512 euros.

Assessment of elderly patients by geriatricians in the Emergency Department and the availability of distinct levels of care are effective resources to avoid inappropriate admissions.