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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the letter by Bard&#233;s Robles et al&#46;<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&#46; 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&#46; The problem still to be resolved is how&#44; when&#44; to whom and by whom&#46; In this respect&#44; 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&#44; from their arrival in the emergency department&#44; those patients who are more likely to have worse outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In fact&#44; this would also be of considerable help when making emergency decisions such as the patient&#39;s initial destination&#44; the risk&#47;benefit balance of performing diagnostic or therapeutic&#47;invasive procedures and admitting the patient to hospital&#46;<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&#44; in the event of a direct discharge&#44; will have a greater likelihood of experiencing an adverse outcome&#46; What is clear is that there is a need to conduct a multidimensional approach&#44; coordinated with primary care for an even closer follow-up after the discharge&#46; Our experience is presented as an alternative for urgently assessing this selected group of elderly patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> To demonstrate this hypothesis&#44; 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&#44; an abbreviated comprehensive geriatric assessment&#44; an intervention on emotional domains and coordination with primary care through a nursing liaison for frail elderly patients discharged from emergency departments&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>"
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Correspondence
DOI: 10.1016/j.rceng.2019.03.025
Intervention program for elderly frail patients discharged from the emergency department
Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias
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F.J. Martín-Sáncheza,b,c, P. Gil Gregoriob,c,d, E. Calvo Manuelb,c,e, C. Fernández Alonsoa,c,
Corresponding author
cesareofa@hotmail.com

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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