PMID- 37839972
OWN - NLM
STAT- MEDLINE
DCOM- 20240206
LR  - 20240206
IS  - 1879-0828 (Electronic)
IS  - 0953-6205 (Linking)
VI  - 120
DP  - 2024 Feb
TI  - Effects of the implementation of the dynamic silver code in the emergency 
      department.
PG  - 80-84
LID - S0953-6205(23)00362-X [pii]
LID - 10.1016/j.ejim.2023.10.007 [doi]
AB  - BACKGROUND: Older persons accessing the Emergency Department (ED) spend more time 
      and are at increased risk of poor outcomes. The Dynamic Silver Code (DSC), based 
      on administrative data, predicts mortality of 75+ subjects visiting the ED. 
      OBJECTIVE: To evaluate the effects of the implementation of the DSC in the ED. 
      METHODS: A pre-post comparison was conducted in the ED of a community hospital in 
      Florence, Italy before and after the DSC was fully implemented. In the post-DSC 
      phase, a clinical decision tree was applied: patients at low-mild risk (DSC class 
      I and II) were assigned to Internal Medicine, those at moderate risk (class III) 
      to Geriatrics, and those at high risk (class IV) required geriatric consultation 
      before assignment. Outcome measures were ED length of stay (LOS) and, in patients 
      admitted to Geriatrics, weight of the Diagnosis Related Groups (DRG), hospital 
      LOS, and mortality. RESULTS: 7,270 patients were enrolled in the pre-DSC and 
      4,725 in the post-DSC phase. ED LOS decreased from a median of 380 [206, 958] in 
      the pre-DSC to 318 [178, 655] min in the post-DSC period (p<0.001). Class III 
      represented the largest share of admissions to Geriatrics in the post-DSC period 
      (57.7 % vs. 38.3 %; p<0.001). In patients admitted to Geriatrics, hospital LOS 
      decreased by one day (p = 0.006) between the two study periods, with greater DRG 
      weight and comparable mortality. CONCLUSIONS: Application of the DSC seemed to 
      ease patient flow and to reduce LOS of older patients in the ED and increased 
      appropriateness of admissions to Geriatrics.
CI  - Copyright (c) 2023 The Authors. Published by Elsevier B.V. All rights reserved.
FAU - Bari, Mauro Di
AU  - Bari MD
AD  - Department of Experimental and Clinical Medicine, University of Florence, 
      Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, 
      Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: 
      mauro.dibari@unifi.it.
FAU - Giordano, Antonella
AU  - Giordano A
AD  - Department of Experimental and Clinical Medicine, University of Florence, 
      Florence, Italy; Agenzia per la Continuita Ospedale-Territorio, Azienda 
      Ospedaliero-Universitaria Careggi, Florence, Italy.
FAU - Giannini, Ilaria
AU  - Giannini I
AD  - Department of Experimental and Clinical Medicine, University of Florence, 
      Florence, Italy.
FAU - Balzi, Daniela
AU  - Balzi D
AD  - Department of Epidemiology, Azienda USL Toscana Centro, Florence, Italy.
FAU - Tonarelli, Francesco
AU  - Tonarelli F
AD  - Department of Experimental and Clinical Medicine, University of Florence, 
      Florence, Italy.
FAU - Benvenuti, Enrico
AU  - Benvenuti E
AD  - Unit of Geriatrics, Department of Internal Medicine, Azienda USL Toscana Centro, 
      Florence, Italy.
FAU - Ruggiano, Germana
AU  - Ruggiano G
AD  - Department of Emergency Medicine, Azienda USL Toscana Centro, Florence, Italy.
FAU - Landini, Giancarlo
AU  - Landini G
AD  - Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy.
FAU - Williamson, Jeff D
AU  - Williamson JD
AD  - Sticht Centre on Healthy Aging and Alzheimer's Prevention, Department of Internal 
      Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of 
      Medicine, Winston-Salem, NC, United States.
FAU - Brooten, Justin K
AU  - Brooten JK
AD  - Sticht Centre on Healthy Aging and Alzheimer's Prevention, Department of Internal 
      Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of 
      Medicine, Winston-Salem, NC, United States; Department of Emergency Medicine, 
      Wake Forest School of Medicine, Winston-Salem, NC, United States.
FAU - Carreras, Giulia
AU  - Carreras G
AD  - Department of Experimental and Clinical Medicine, University of Florence, 
      Florence, Italy.
LA  - eng
PT  - Journal Article
DEP - 20231013
PL  - Netherlands
TA  - Eur J Intern Med
JT  - European journal of internal medicine
JID - 9003220
RN  - 3M4G523W1G (Silver)
SB  - IM
MH  - Humans
MH  - Aged
MH  - Aged, 80 and over
MH  - *Silver
MH  - Hospitalization
MH  - Emergency Service, Hospital
MH  - Length of Stay
MH  - *Geriatrics
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Dynamic silver code
OT  - Emergency department
OT  - Frail elderly
OT  - Prognostic assessment
COIS- Declaration of Competing Interest None.
EDAT- 2023/10/16 00:42
MHDA- 2024/02/06 06:42
CRDT- 2023/10/15 22:00
PHST- 2023/05/20 00:00 [received]
PHST- 2023/08/21 00:00 [revised]
PHST- 2023/10/05 00:00 [accepted]
PHST- 2024/02/06 06:42 [medline]
PHST- 2023/10/16 00:42 [pubmed]
PHST- 2023/10/15 22:00 [entrez]
AID - S0953-6205(23)00362-X [pii]
AID - 10.1016/j.ejim.2023.10.007 [doi]
PST - ppublish
SO  - Eur J Intern Med. 2024 Feb;120:80-84. doi: 10.1016/j.ejim.2023.10.007. Epub 2023 
      Oct 13.