Pitfalls in the emergency department triage of frail elderly patients without specific complaints

• Published in: Swiss medical weekly Vol. 135; no. 9-10; pp. 145 - 150
• Main Authors: Rutschmann, Olivier T, Chevalley, Thierry, Zumwald, Catherine, Luthy, Christophe, Vermeulen, Bernard, Sarasin, François P
• Format: Journal Article
• Language: English
• Published: Switzerland 05.03.2005
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Emergency Service, Hospital; Female; Frail Elderly; Geriatric Assessment; Health Services Needs and Demand; Hospitals, University; Humans; Male; Outcome Assessment (Health Care); Patient Admission; Patient Discharge; Switzerland; Triage; Switzerland
• ISSN: 1424-7860; 1424-3997

Elderly patients represent an increasing proportion of emergency department (ED) admissions. When no specific complaint is identified, the reason for referral is commonly called "home care impossible". The aim of this study was to describe a population of elderly patients who present to the ED of a 1200-bed university hospital without specific complaint, and to assess how they were evaluated in the ED. Data on triage, mode of admission and discharge were collected. After the initial evaluation in the ED, patients were classified in two categories: (1) patients identified with a medical problem requiring rapid care or investigation, (2) patients without a medical problem considered as true "home care impossible". These latter patients underwent a complete assessment using the Minimal Data Set-Home Care (MDS-HC). During the 10-week study period 253 patients (mean age 81 years) were referred because of "home care impossible". An acute medical problem was identified in 129 of those patients (51%). All these patients were triaged in lower acuity categories. 33 (26%) were undertriaged due to (1) absence of vital signs measurement, (2) poor recognition of neurological symptoms, (3) atypical clinical presentation. The remaining patients were considered as true "home care impossible". The MDS-HC evaluation revealed a high level of biopsychosocial comorbidities. Frail elderly patients admitted without specific complaints are at risk of inappropriate or delayed evaluation due to undertriage at the door of the ED. A more specific geriatric assessment should be integrated early in the triage process of these patients.