The Association Between Frailty and a Nurse-Identified Need for Comprehensive Geriatric Assessment Referral from the Emergency Department.
Fabrice I Mowbray, Brittany Ellis, Connie Schumacher and 7 others
PMID 36632010WHAT IT FOUND
A 0.1 unit increase in frailty in older ED patients was associated with a 34% higher chance that an emergency nurse documented a need for comprehensive geriatric assessment, but only 5% were referred by the treating physician.
Key findings
01A 0.1 unit increase in the ED frailty index increased the likelihood of an emergency nurse documenting a need for comprehensive geriatric assessment by 34%, an absolute difference of 6.6%.
0228% of the cohort had a nurse-identified need for comprehensive geriatric assessment, but only 5% were referred to geriatric services by the treating physician.
03Older adults with high medical acuity had 50% lower odds of a nurse-identified need for comprehensive geriatric assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study analysed archived data, so it could not check whether the nurse-identified need for comprehensive geriatric assessment was accurate against a geriatrician assessment. Frailty was calculated after the ED assessment and was not available to guide care, so the association is with nurses' documentation, not with frailty influencing their decision. Only 2,024 patients had frailty scores, and the frailty model analysed 1,953, so some participants were excluded from the main analysis. Data were mostly daytime and collected about a decade ago, and patients transferred from post-acute care were excluded.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not conclude that comprehensive geriatric assessment referral improves outcomes or that most older ED patients should be referred. The outcome was a nurse-identified need, not a validated assessment, and the paper reports that only 5% received physician referral.