Addressing Frailty in the Emergency Department: Early Outcomes of a Geriatric Rapid Access Clinic

OBJECTIVES: Older adults represent a growing proportion of emergency department (ED) visits, with an increased risk of adverse outcomes following discharge, particularly when frailty is present. Access to post-ED geriatric follow-up is often delayed, leaving patients without timely support and increasing their risk of ED revisits and subsequent hospital admissions. This study evaluates a novel Geriatric Rapid Access Clinic (Geri-RAC) designed to provide expedited, specialized follow-up for high-risk older adults discharged from the ED. METHODS: A retrospective chart review was conducted of all patients who attended the Geri-RAC at a large academic hospital in Toronto from January 2023 to July 2024. Older adults identified as high-risk in the ED were referred to the clinic. Patient outcomes included ED revisit rates and anticipated hospital admission avoidance; data on clinic performance indicators, patient characteristics, and accessed supports were also measured. RESULTS: Thirty-three patients attended the Geri-RAC during the 19-month pilot. Mean age was 82.6 years, with 81.8% having a Clinical Frailty Scale score ≥ 4. Functional limitations were present in 69.7% of patients. Median wait time from ED referral to appointment was 7 days. Cognitive testing was conducted in 78.7% of attendees and medication de-prescribing was initiated in 48.5%. Most patients (87.9%) were newly connected to support services, averaging 2.6 ± 2.1 service linkages per patient. 45.5% of patients received new specialist referrals. The 7-, 30-, and 90-day ED revisit rates were 0%, 12.1%, and 24.2%, respectively. Admission avoidance was anticipated in 42.4% of cases. CONCLUSIONS: The Geri-RAC provided timely access to post-ED follow-up and multidisciplinary care for frail older adults. Early findings highlight the potential for this model to enhance ED discharge planning, facilitate structured care transitions, and decrease reliance on emergency services in this high-risk population.