Emergency-department-embedded geriatric assessment discharges most older patients home with hospital-at-home support rather than admission

A retrospective cohort study of 8,113 emergency department patients (median age 88) evaluated the GIROT-ED model, which integrates comprehensive geriatric assessment (CGA) directly into emergency department workflow rather than after an admission decision has already been made Primary Study. 63% of patients were discharged home with hospital-at-home support instead of being admitted, with low 72-hour revisit and mortality rates recorded (Verga et al.1, PMID: 42629536).

The model tests a specific design choice: performing geriatric assessment and disposition planning at the point of first contact, rather than treating hospital-at-home as a downstream alternative considered only once a patient has already been admitted. This is retrospective, single-model cohort data rather than a randomised comparison, so causal claims about the 63% conversion rate should be read with that design limitation in mind.

For services designing or auditing front-door frailty pathways, the finding offers a concrete comparator for the proportion of ED-CGA-assessed patients who can be safely diverted to home-based support at first contact, rather than an estimate of what any specific service should expect to achieve.