Emergency Department Interventions for the Frail Elderly (EDIFY)

Year Submitted: 2025
Published Date: 08 April 2025

Tags: Training ＆ Education, Technology, Professional Development

About this Content

Aims

The EDIFY program was developed to deliver early geriatric specialist interventions at the Emergency Department (ED) to reduce the number of acute admissions by identifying patients for safe discharge or transfer to low-acuity care settings. We evaluated the effectiveness of EDIFY in reducing potentially avoidable acute admissions.

Methods

Design: A quasi experimental study. Setting: ED of a 1700-bed tertiary hospital. Participants: ED patients aged ≥85 years. Measurements: We compared EDIFY interventions versus standard-care. Patients with plans for acute admission were screened and recruited. Data on demographics, premorbid function, frailty status, co-morbidities, and acute illness severity were gathered. We examined the primary outcome of “successful acute admission avoidance” among the intervention group, which was defined as no ED attendance within 72-hours of discharge from ED, no transfer to an acute ward from subacute care units (SCU) within 72-hours, or no transfer to an acute ward from the short-stay unit (SSU). Secondary outcomes were rehospitalization, ED re-attendance, institutionalization, functional decline, mortality, and frailty transitions at 1-, 3-, and 6-months.

Results

We recruited 100 participants (mean age 90.0±4.1 years, 66.0% females). There were no differences in baseline characteristics between intervention (n=43) and non-intervention (n=57) groups. Thirty-five (81.4%) participants in the intervention group successfully avoided an acute admission (20.9% home, 23.3% SCU, and 44.2% SSU). All participants in the non-intervention group were hospitalized. There were no differences in rehospitalization, ED reattendance, institutionalization and mortality over the study period. Additionally, we observed a higher rate of progression to a poorer frailty category at all time-points among the non-intervention group (1-,3- and 6-months: all p

Conclusion

Results from our single-centre study suggest that early geriatric specialist interventions at the ED can reduce potentially avoidable acute admissions without escalating the risk of rehospitalization, ED re-attendance or mortality, and with possible benefit in attenuating frailty progression

Lessons Learnt

Firstly, this project comprises 2 concurrent studies 1) Study 1: Quasi-experimental study investigating effectiveness of EDIFY interventions in reducing acute admissions and 2) Study 2: Quasi-experimental study investigating effective of EDIFY interventions in maintaining OR improving functional status in ED attendees with clinical frailty scale 4-6 at the EDTC unit of the ED. Given that both studies were running concurrently, there were a lot of logistically challenges in ensuring a smooth and effective recruitment and follow-up process is maintained. At the end, we were not able to achieve our calculated sample size and had to end our recruitment process prematurely for Study 1. Nevertheless, despite being short of our target sample size, we were still able to demonstrate effectiveness of EDIFY intervention in reducing acute admissions. Key lessons learnt from this experience include: 1) Recruitment of patients at the ED, especially in older adults, can be very challenging as patients/NOKs may be less willing to participate, especially when they may be at a heightened state of anxiety/stress. Hence, it was important for us to develop certain methods to overcome this challenge. Firstly, we needed to ensure our study explanations were done succinctly yet covered all the key elements for obtaining written consent. And secondly, we needed to ensure we had a study member ready and available to recruit patients in a timely manner, this can sometimes we challenging, especially when patients are still being sent for further investigations at the ED. 2) Having a multidisciplinary study team who can share their ideas and concerns from their own perspectives do help immensely with the study planning and protocol design, and 3) Given the complexity of the study methodology, having a dry run before commencing the study proper was most useful and allowed us sufficient time to make the necessary changes to our approach in recruiting patients effectively.

Keywords

Acute Admission Avoidance, Front-Door Geriatrics

Innovators' Details

Connect with this contributor!

Dr Edward Chong - edward_chong@ttsh.com.sg

Project Attachment