Re-admission following discharge from a Geriatric Evaluation and Management Unit: identification of risk factors
Sally Yin A * , Jennifer Paratz B and Michelle Cottrell AA Physiotherapy Department, Royal Brisbane and Women’s Hospital, Level 2 Ned Handlon Building, Herston, Brisbane, Qld 4029, Australia.
B Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Level 8, UQ Centre for Clinical Research (UQCCR), Royal Brisbane and Women’s Hospital, Herston, Brisbane, Qld 4029, Australia.
Australian Health Review 46(4) 421-425 https://doi.org/10.1071/AH21357
Submitted: 16 November 2021 Accepted: 20 May 2022 Published: 17 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To establish independent factors that influence the likelihood of re-admission within 30 days of discharge from a Geriatric Evaluation and Management Unit.
Methods An observational prospective cohort design using clinical data extracted from the medical charts of eligible patients discharged from a tertiary public hospital Geriatric Evaluation and Management Unit between July 2017 and April 2019. Binary logistic regression was undertaken to determine variables that increased the likelihood of hospital re-admission (dependent variable).
Results A total of 367 patients were eligible for inclusion, with 69 patients re-admitted within 30 days of discharge. Univariate analysis demonstrated significant differences between groups (re-admission vs non-re-admission) with respect to Charlson Comorbidity Index (CCI) (7.4 [2.4] vs 6.3 [2.2], P = 0.001), Clinical Frailty Scale (CFS) (5.6 [1.1] vs 5.2 [1.34], P = 0.02), and documented malnourishment (36.2% vs 23.6%, P = 0.04). All three variables remained significant when entered into the regression model (X2 = 25.095, P < 0.001). A higher score for the CFS (OR 1.3; 95% CI 1.03–1.64; P = 0.03) and CCI (OR 1.2; 95% CI 1.06–1.33; P = 0.004), and documented malnourishment (OR 1.92; 95% CI 1.06–3.47; P = 0.03) were all independent factors that increased the likelihood of patient re-admission within 30 days of discharge.
Conclusions This study supports the formal inclusion of the CCI and CFS into routine practice in Geriatric Evaluation and Management Units. The inclusion of the measures can help inform future discharge planning practices. Clinicians should use malnourishment status, CCI and CFS to identify at risk patients and target discharge planning interventions accordingly.
Keywords: comorbidities, frailty, Geriatric Evaluation and Management Unit, malnutrition, re-admission.
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