Intervention program for elderly frail patients discharged from the emergency department

Martín-Sánchez, F.J.; Gil Gregorio, P.; Calvo Manuel, E.; Fernández Alonso, C.

doi:10.1016/j.rceng.2019.03.025

array:23 ["pii" => "S2254887419301158" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.03.025" "estado" => "S300" "fechaPublicacion" => "2019-08-01" "aid" => "1661" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2019;219:350" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S001425651930102X" "issn" => "00142565" "doi" => "10.1016/j.rce.2019.03.011" "estado" => "S300" "fechaPublicacion" => "2019-08-01" "aid" => "1661" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2019;219:350" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 63 "formatos" => array:2 [ "HTML" => 38 "PDF" => 25 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "Carta al Director" "titulo" => "Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "350" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Intervention programme for elderly frail patients discharged from the emergency department" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Martín-Sánchez, P. Gil Gregorio, E. Calvo Manuel, C. Fernández Alonso" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Martín-Sánchez" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Gil Gregorio" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Calvo Manuel" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Fernández Alonso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887419301158" "doi" => "10.1016/j.rceng.2019.03.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301158?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651930102X?idApp=WRCEE" "url" => "/00142565/0000021900000006/v1_201907300642/S001425651930102X/v1_201907300642/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2254887419301249" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.04.003" "estado" => "S300" "fechaPublicacion" => "2019-08-01" "aid" => "1667" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2019;219:348-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Correspondence" "titulo" => "Analysis of the disease burden of influenza in the last five seasons (2013–2018)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "348" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la carga de enfermedad de la gripe en las últimas cinco temporadas (2013-2018)" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1308 "Ancho" => 2083 "Tamanyo" => 94621 ] ] "descripcion" => array:1 [ "en" => "Evolution of the influenza burden in percentages over the total number of samples analyzed and the total number of samples positive to respiratory viruses." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Reina, P. Fraile, J. Murillas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Reina" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Fraile" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Murillas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256519301080" "doi" => "10.1016/j.rce.2019.04.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256519301080?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301249?idApp=WRCEE" "url" => "/22548874/0000021900000006/v1_201907300655/S2254887419301249/v1_201907300655/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Correspondence" "titulo" => "Intervention program for elderly frail patients discharged from the emergency department" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "350" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F.J. Martín-Sánchez, P. Gil Gregorio, E. Calvo Manuel, C. Fernández Alonso" "autores" => array:4 [ 0 => array:3 [ "nombre" => "F.J." "apellidos" => "Martín-Sánchez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Gil Gregorio" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Calvo Manuel" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 3 => array:4 [ "nombre" => "C." "apellidos" => "Fernández Alonso" "email" => array:1 [ 0 => "cesareofa@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "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" => "We have read the letter by Bardés Robles et al.<a class="elsevierStyleCrossRef" href="#bib0030">1</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">2</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">3</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">4</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">2</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">5</a>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "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." ] ] "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. Herrero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2018.09.006" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2019" "volumen" => "219" "paginaInicial" => "58" "paginaFinal" => "59" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30389170" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intervención multidimensional que mejora el pronóstico a corto plazo entre los ancianos frágiles dados de alta desde una unidad de corta estancia: estudio cuasiexperimental" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fernández Alonso" 1 => "M. Fuentes Ferrer" 2 => "M.I. Jiménez Santana" 3 => "L. Fernández Hernández" 4 => "M. de la Cruz García" 5 => "J. González del Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2018.01.008" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2018" "volumen" => "218" "paginaInicial" => "163" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29499984" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Valor de los instrumentos ISAR y TRST para predecir resultados adversos en población general geriátrica asistida en los servicios de urgencias: metanálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Rivero-Santana" 1 => "T. del Pino-Sedeño" 2 => "Y. Ramallo-Fariña" 3 => "I. Vergara" 4 => "P. Serrano-Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "49" "paginaFinal" => "60" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identification of Senior At Risk scale predicts 30-day mortality among older patients with acute heart failure" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Resto de investigadores del registro OAK" "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "G. Llopis García" 2 => "M. González-Colaço Harmand" 3 => "C. Fernandez Pérez" 4 => "J. González del Castillo" 5 => "P. Llorens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.07.009" "Revista" => array:3 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "itemHostRev" => array:3 [ "pii" => "S1933287416303786" "estado" => "S300" "issn" => "19332874" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Planiﬁcación del alta desde urgencias para reducir eventos adversos a 30 días en pacientes mayores frágiles con insuﬁciencia cardiaca aguda: diseño y justiﬁcación del ensayo clínico DEED FRAIL-AHF" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín Sánchez" 1 => "G. Llopis García" 2 => "P. Llorens" 3 => "J. Jacob" 4 => "P. Herrero" 5 => "P. Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "27" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30656886" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000006/v1_201907300655/S2254887419301158/v1_201907300655/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000006/v1_201907300655/S2254887419301158/v1_201907300655/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419301158?idApp=WRCEE"]

Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

Indexed in:

Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

View more metrics

Open Access Option

Journal Information

Previous article | Next article

Vol. 219. Issue 6.

Pages 350 (August - September 2019)

Lee este artículo en Español

Export reference

Download PDF

Article

These are the options to access the full texts of the publication Revista Clínica Española (English Edition)

Member of the society

Subscriber

Contact

Member

Si es usted socio de FESEMI siga los siguientes pasos:

Diríjase desde aquí a la web de la >>>FESEMI<<< e inicie sesión mediante el formulario que se encuentra en la barra superior, pulsando sobre el candado.