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Additional file 1: Supplementary table 1. Information about important study basline covariates. Supplementary table 2. Two way cross-tabulation of CFS and HFRS categories — original categories. Supplementary table 3. Two way cross-tabulation of CFS and HFRS categories — frail versus non-frail categories. Supplementary table 4. Hospital-related outcomes by CFS, HFRS categories – mean (SD) and frequencies (%). Supplementary table 5. Adjusted logistic regression for study covariates in the CFS and HFRS multivariate logistic regression models. Supplementary table 6. Univariate logistic regression for the CFS and HFRS. Supplementary table 7. Available studies assessing the ability of the HFRS to predict hospital-related outcomes (mortality, LOS, and readmission). Supplementary table 8. Previous studies assessing the ability of the ED-CFS to predict hospital-related outcomes.

Abdullah Alshibani,1,2 Jay Banerjee,1,3 Fiona Lecky,4 Timothy J Coats,3,5 Meshal Alharbi,2,5 Simon Conroy1 1Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK; 2Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3University Hospitals of Leicester NHS Trust, Leicester, UK; 4Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, UK; 5Department of Cardiovascular Sciences, University of Leicester, Leicester, UKCorrespondence: Abdullah AlshibaniDepartment of Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, 15 Lancaster Road, Leicester, LE1 7HA, UKEmail anaa3@le.ac.ukAbstract: Caring for older people is an important part of prehospital practice, including appropriate triage and transportation decisions. However, prehospital triage criteria are designed to predominantly assess injury severity or high-energy mechanism which is not the case for older people who often have injuries compounded by multimorbidity and frailty. This has led to high rates of under-triage in this population. This narrative review aimed to assess aspects other than triage criteria to better understand and improve prehospital triage decisions for older trauma patients. This includes integrating frailty assessment in prehospital trauma triage, which was shown to predict adverse outcomes for older trauma patients. Furthermore, determining appropriate outcome measures and the benefits of Major Trauma Centers (MTCs) for older trauma patients should be considered in order to direct accurate and more beneficial prehospital trauma triage decisions. It is still not clear what are the appropriate outcome measures that should be applied when caring for older trauma patients. There is also no strong consensus about the benefits of MTC access for older trauma patients with regards to survival, in-hospital length of stay, discharge disposition, and complications. Moreover, looking into factors other than triage criteria such as distance to MTCs, patient or relative choice, training, unfamiliarity with protocols, and possible ageism, which were shown to impact prehospital triage decisions but their impact on outcomes has not been investigated yet, should be more actively assessed and investigated for this population. Therefore, this paper aimed to discuss the available evidence around frailty assessment in prehospital care, appropriate outcome measures for older trauma patients, the benefits of MTC access for older patients, and factors other than triage criteria that could adversely impact accurate prehospital triage decisions for older trauma patients. It also provided several suggestions for the future.Keywords: undertriage, geriatrics, injury, emergency, paramedics, frailty

The file attached to this record is the author's final peer reviewed version. Purpose We conducted a scoping review of quality improvement in care homes. We aimed to identify participating occupational groups and methods for evaluation. Secondly, we aimed to describe resident-level interventions and which outcomes were measured. Methods Following extended PRISMA guideline for scoping reviews, we conducted systematic searches of Medline, CINAHL, Psychinfo, ASSIA (2000-2019). Furthermore, we searched systematic reviews databases including Cochrane Library and JBI, and the grey literature database, Greylit. Four co-authors contributed to selection and data extraction. Results 65 studies were included, 6 of which had multiple publications (75 articles overall). A range of quality improvement strategies were implemented, including audit-feedback and quality improvement collaboratives. Methods consisted of controlled trials, quantitative time series and qualitative interview and observational studies. Process evaluations, involving staff of various occupational groups, described experiences and implementation measures. Many studies measured resident-level outputs and health outcomes. 14 studies reported improvements to a clinical measure, however four of these articles were of low quality. Larger randomized controlled studies did not show statistically significant benefits to resident health outcomes. Conclusion In care homes, quality improvement has been applied with several different strategies, being evaluated by a variety of measures. In terms of measuring benefits to residents, process outputs and health outcomes have been reported. There was no pattern of which quality improvement strategy was used for which clinical problem. Further development of reporting of quality improvement projects and outcomes could facilitate implementation.