Correspondence
Intervention program for elderly frail patients discharged from the emergency department
Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias
F.J. Martín-Sáncheza,b,c, P. Gil Gregoriob,c,d, E. Calvo Manuelb,c,e, C. Fernández Alonsoa,c,
Corresponding author
a Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
b Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
c Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
d Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain
e Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
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"apellidos" => "Fernández Alonso" "email" => array:1 [ 0 => "cesareofa@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the letter by Bardés Robles et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and would like to add a few points as a reply to their comments on the intervention for frail elderly patients in emergency departments. It is clear that we share with the authors the need for identifying elderly frail patients to apply the geriatric assessment and design an individualized care plan. The problem still to be resolved is how, when, to whom and by whom. In this respect, the proposal documented in our study<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> would be to incorporate frailty screening scales into the current triage systems in order to identify, from their arrival in the emergency department, those patients who are more likely to have worse outcomes.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In fact, this would also be of considerable help when making emergency decisions such as the patient's initial destination, the risk/benefit balance of performing diagnostic or therapeutic/invasive procedures and admitting the patient to hospital.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> The big unanswered question is what to do with an elderly patient identified as frail who does not meet the criteria for hospital admission and who, in the event of a direct discharge, will have a greater likelihood of experiencing an adverse outcome. What is clear is that there is a need to conduct a multidimensional approach, coordinated with primary care for an even closer follow-up after the discharge. Our experience is presented as an alternative for urgently assessing this selected group of elderly patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> To demonstrate this hypothesis, a multicenter clinical trial will be conducted to determine whether the short-term results will be improved by a comprehensive approach that includes frailty screening, an abbreviated comprehensive geriatric assessment, an intervention on emotional domains and coordination with primary care through a nursing liaison for frail elderly patients discharged from emergency departments.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Sánchez FJ, Gil Gregorio P, Calvo Manuel E, Fernández Alonso C. Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias. Rev Clin Esp. 2019;219:350.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intervención en ancianos frágiles desde urgencias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Bardés Robles" 1 => "E. Rodríguez Adrada" 2 => "R. Escoda" 3 => "P. 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