Comprehensive geriatric assessment in the emergency department

Area of Science:

• Geriatric Medicine
• Emergency Medicine
• Health Services Research

Background:

• Comprehensive geriatric assessments (CGA) are proven beneficial for frail patients in acute hospitals.
• National guidelines advocate for inpatient CGAs, showing links to improved 12-month survival and community dwelling.
• The effectiveness of CGAs performed in emergency departments (ED-CGA) for admission avoidance and reducing 30-day reattendance is less understood.

Purpose of the Study:

• To review existing studies on the impact of emergency department comprehensive geriatric assessments (ED-CGA) on subsequent secondary care attendance.
• To evaluate the evidence regarding the effectiveness of ED-CGAs in preventing 30-day reattendance or readmission.

Main Methods:

• A review of five studies examining the impact of ED-CGAs on secondary care attendance.
• Included studies comprised two randomized-controlled trials, one case-matched cohort study, and two quasi-experimental pre- and post-intervention studies.
• Analysis focused on studies measuring reattendance or readmission rates within 30 days post-discharge.

Main Results:

• The reviewed studies reported variable success in preventing subsequent secondary care utilization.
• No studies included were conducted in the UK, limiting the generalizability of findings.
• There is no clear evidence that ED-CGAs reduce 30-day reattendances or readmissions.

Conclusions:

• The current evidence base for ED-CGAs is heterogeneous, methodologically varied, and susceptible to bias.
• Further research is required to identify optimal screening methods for target populations and the impact of intervention intensity.
• While ED-CGAs may not clearly improve cost or service delivery metrics, they might offer significant patient-centered benefits requiring further investigation.