Can consultant geriatrician led comprehensive geriatric assessment in the emergency department reduce hospital admission rates? A systematic review

Objective: economic and demographic pressures are driving a need to reassess the way in which we care for older patients presenting to emergency departments (EDs). This systematic review seeks to assess the extent to which performing comprehensive geriatric assessment (CGA) in the ED can reduce admission rates. Design: systematic search of both published and unpublished literature to identify studies reporting admission rates following the introduction of consultant geriatrician led teams performing CGA in the ED. Changes in inpatient length of stay and subsequent readmission rates were identified as secondary outcome measures. Results: five studies with a total of 28,434 participants were included. All of the studies reported statistically significant reductions in admission rates (ranging between 2.6 and 19.7%). However, variation in the degree of changes leads to uncertainty as to the financial viability of the intervention. No studies have yet examined the clinical effects of performing CGA within the ED. The results were far more varied with regards to inpatient length of stay and readmission rates, indicating that complex local factors, such as the design of community support services, may play an important role. Conclusion: consultant geriatrician led teams performing CGA within the ED can reduce admissions rates among older patients. It is unclear as to what impact such interventions have upon readmission rates or inpatient length of stay. Future research is needed to assess the clinical outcomes and financial viability of such admissions avoidance teams. PROSPERO registration number: CRD42016038840.