Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial

Area of Science:

• Geriatric Medicine
• Emergency Medicine
• Public Health

Background:

• Older adults frequently present to emergency departments (EDs) with complex needs.
• Risk stratification and geriatric screening can identify vulnerable patients.
• Early intervention may prevent functional decline and reduce healthcare utilization.

Purpose of the Study:

• To evaluate the impact of risk stratification and rapid geriatric screening in the ED on functional decline.
• To assess the effect of this intervention on emergency department reattendance and hospitalisation rates.
• To determine the effectiveness of a targeted geriatric care pathway initiated in the ED.

Main Methods:

• A quasi-randomised controlled trial was conducted with patients randomised by the last digit of their national registration identity card (NRIC).
• The intervention group received geriatric screening and onward referrals, while the control group received standard ED care.
• Follow-up was conducted over 12 months to assess functional outcomes and healthcare utilization.

Main Results:

• The intervention group showed significant preservation of function (Basic ADL and IADL) at 12 months compared to the control group.
• Higher Triage Risk Screening Tool (TRST) scores and lower baseline Instrumental Activity of Daily Living (IADL) scores were observed in the intervention group.
• While not statistically significant, reductions in ED reattendance and hospitalisation were noted, with limitations due to patient refusal/departure and cross-over care.

Conclusions:

• Risk stratification and focused geriatric screening in the ED significantly preserve patients' function at 12 months.
• The findings support the implementation of targeted geriatric interventions within the emergency department setting.
• Further research is needed to optimize patient engagement and address barriers to intervention uptake.