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Nouvenne A, Ticinesi A, Cerundolo N, Prati B, Parise A, Chiussi G, Frosio L, Guerra A, Brianti E, Fabi M, Meschi T. Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data. Aging Clin Exp Res 2022; 34:599-609. [PMID: 34472045 DOI: 10.1007/s40520-021-01967-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. AIMS To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h. METHODS The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests. RESULTS Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty. CONCLUSIONS The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients.
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Affiliation(s)
- Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Andrea Ticinesi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giulia Chiussi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Laura Frosio
- Post-Graduate Specialization Course in Emergency-Urgency Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Angela Guerra
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ettore Brianti
- General Management, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy
| | - Massimo Fabi
- General Management, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy
| | - Tiziana Meschi
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Chen SX, Fan K, Leung LP. Epidemiological characteristics and disease spectrum of emergency patients in two cities in China: Hong Kong and Shenzhen. World J Emerg Med 2020; 11:48-53. [PMID: 31893003 DOI: 10.5847/wjem.j.1920-8642.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shao-Xi Chen
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Karren Fan
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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