The effectiveness of an emergency physician–led frailty unit for the living-alone elderly: A pilot retrospective cohort study.

Background: We are facing an ageing population in Hong Kong. In response to the surge in service demand resulted from Silver Tsunami, a six-bed frailty unit was established in the Emergency Medicine Ward of Queen Elizabeth Hospital in December 2015. Frailty unit offers a bundle of multi-disciplinary approach for geriatric patients with an aim for early supported discharge. Objective: To evaluate whether this novel frailty care pathway, compared to the conventional general care pathway, would improve the outcome of the local elderly who were living alone. Method: This is a retrospective cohort study. Patients who were admitted from 1 September 2015 to 31 October 2017 were included in this study. Data were retrieved from the electronic patient record (ePR) of Hospital Authority. The outcome measurements are lengths of stay in acute and convalescent hospitals, transferral rate to a convalescent hospital and 28-day re-attendance rate. Results: A total of 190 patients were recruited (150 frailty vs 40 general). Baseline characteristics, including age, gender distribution, vital signs, laboratory results, use of mobility aids, Morse fall risk scale, Norton ulcer scale and Barthel Index were similar in both groups; except a higher diastolic blood pressure in novel frailty-care pathway. The length of stay in the acute hospital is significantly shortened (2.38 vs 3.27 days, p = 0.00018). The transferral rate to a convalescent hospital was less in frailty group (21.3% vs 42.5%, p = 0.00655). There was no significant difference in terms of total (7.10 vs 10.99 days, p = 0.09638) and convalescent (22.09 vs 18.16 days, p = 0.48183) length of stay between frailty group and general group, respectively; while the 28-day re-attendance rate was similar (26.7% vs 15.0%, p = 0.12589). Conclusion: This is a pilot study to first report a novel frailty-care model for the local geriatric population. It has shown a reduction in length of stay in acute hospital and transferral rate to convalescent hospitals, while introducing a non-significant reduction in total hospital stay, maintaining 28-day re-attendance rate and at an expense of a probable increase in the convalescent stay. [ABSTRACT FROM AUTHOR]