Ambulatory care for older people living with frailty: an innovative use of the medical day hospital

Medical day hospitals (MDH) provide multidisciplinary care to older people living with frailty in an outpatient or day-case setting. Given the pressures on UK emergency departments (ED) combined with the rising numbers of frail older adults presenting as emergencies, we hypothesised that it would be possible for our MDH to be used to provide multidisciplinary ambulatory care for a subset of older patients presenting to ED. With adequate resources, this could potentially provide comprehensive geriatric assessment in an older-friendly environment with the additional benefit of improved flow within the ED. This paper discusses outcomes for the first 100 patients transferred from the ED to be assessed and managed within the MDH instead. Clinical judgement was used to select older patients who were likely to be able to go home the same day after assessment and multidisciplinary input within the MDH. As expected with a highly selected cohort, of the 100 patients transferred, 92% were discharged, noting that medical admission had already been planned for 31% of these patients prior to the involvement of the geriatrician. In conclusion, it is feasible for a cohort of older patients presenting to the ED to be managed within the MDH instead with additional potential for reducing avoidable admissions.