Aims: To assess the association between outpatient Comprehensive Geriatric Assessment (CGA) at a Frailty Rapid Access Clinic (FRAC) following discharge from the Emergency Department (ED) and ED re-presentations and hospital admissions.
Methods: This prospective cohort study included patients aged ³70 years, discharged from Sir Charles Gairdner Hospital ED in Western Australia between June 2020 and February 2021, who attended follow-up outpatient CGA at FRAC. Primary outcomes were ED re-presentation rate and hospital admissions in the 12 months following initial FRAC attendance, compared to the 12 months prior to initial FRAC attendance. Secondary outcomes were: ED re-presentations at 30, 60 and 90 days; waiting time in days from ED discharge to outpatient CGA; and hospital LOS. Secondary analysis was performed to assess for differences in outcomes depending on patient characteristics: Clinical Frailty Scale (CFS), age and presence of geriatric syndromes.
Results: 96 patients were included. FRAC attendance was associated with reduced ED re-presentation rate in the 12 months following FRAC compared to the 12 months prior to FRAC (1.18 vs 2.30, 95% CI 1.87-2.73, P <0.001). This reduction was not maintained in patients over age 90 years, nor in patients with mild (CFS 1-4) or severe (CFS 7-8) frailty. FRAC attendance was not associated with hospital admissions or hospital LOS. Mean waiting time for CGA was 19 days, and 27% of patients re-presented to ED within 90 days.
Conclusion: FRAC is an outpatient CGA model associated with reduction in ED re-presentations in patients age 70-90 years with moderate frailty (CFS 5-6).