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The number of older patients admitted to acute hospitals has increased; however, their needs are heterogeneous and there is no gold‐standard method of triaging them towards practicing comprehensive geriatric assessment ( CGA ). In our hospital, the  SAFE  (Specialist Advice for the Frail Elderly) team provide an initial geriatric assessment of all emergency admissions of patients aged ≥75 years (with some assessments also occurring in those aged 65 to 74 years) and recommend as to whether  CGA  in a dedicated Department of Medicine for the Elderly ( DME ) ward may be required.  SAFE  assessments include routine screening for geriatric syndromes using validated tools. Our aim was to compare the characteristics (age, gender, acute illness severity on admission as per modified early warning score ( MEWS ), Charlson Comorbidity Index, Clinical Frailty Scale ( CFS ), presence of dementia and delirium) and outcomes (length of stay, delayed discharge, inpatient mortality, discharge to usual place of residence, and new institutionalization) of patients listed to a  DME  ward, to those not listed. We analyzed all  SAFE  team assessments of patients admitted nonelectively between February 2015 and November 2016. Of 6192 admissions, 16% were listed for a  DME  ward. Those were older, had higher  MEWS  and  CFS  score, were more often affected by cognitive impairment, had longer hospital stay, higher inpatient mortality, and more often required new institutionalization. Higher  CFS  and presence of dementia and delirium were the strongest predictors of  DME  ward recommendation. Routine measurement of markers of geriatric complexity may help maximize access to finite inpatient  CGA  resources.

aging medicine

Allocating patients to geriatric medicine wards in a tertiary university hospital in England: A service evaluation of the Specialist Advice for the Frail Elderly ( SAFE ) team