Introduction Enhanced care units (ECU) are a novel concept, targeting the gap between ward-level and critical care. They care for patients requiring intensive medical or nursing care, who may not require, desire, or be suitable for, escalation above ward care (Society of Acute Medicine and Intensive Care Society, 2022). The ECU at Barnet Hospital opened in March 2022, and, because of the local population demographic, admits a high number of older patients living with frailty. We aimed to assess the performance of the ECU for this subset of patients. Methods A retrospective audit of electronic records of 75 randomly selected patients admitted to ECU between March and August 2023. Data were gathered on Clinical Frailty Score (CFS) at baseline, comorbidity, escalation status, APACHE II illness severity score, and outcome measures. Results The majority of patients in the sample, 52 of 75 (69.3%), were over 65 years of age with an average of 69.1 years. Baseline frailty score was high, with a modal CFS of 6. Of these patients, 32 (61.5%) had a DNACPR, and 17 (32.7%) had treatment ceiling at ECU level. Illness severity was similar across CFS groups, with a mean APACHE II score of 15.2 (representing a 25% mortality risk). Overall mortality in the over 65 s was 23.1% (12/52), without significant change when stratified by CFS. Mortality in the under 65 s was 8.7% (2/23). Conclusions Acutely unwell patients with frailty may benefit from ECU level care. In our centre, we found no significant increase in mortality linked to a higher frailty score. We suggest that this may represent good case selection by clinicians experienced in working with frailty: admitting patients with more reversibility and targeting therapies towards reversible causes. Limitations remain, especially in assessing illness severity, as the assessment tools are not targeted to this cohort.

中文翻译：

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2203 避免危重老年人的治疗虚无主义：加强虚弱患者的单一中心方法


简介 增强型护理病房 （ECU） 是一个新颖的概念，针对病房级和重症监护之间的差距。他们照顾需要重症医疗或护理的患者，这些患者可能不需要、不希望或不适合升级至病房护理以上（急性医学学会和重症监护学会，2022 年）。巴尼特医院的 ECU 于 2022 年 3 月开放，由于当地人口结构丰富，收治了大量虚弱的老年患者。我们旨在评估 ECU 对这部分患者的性能。方法 对 2023 年 3 月至 8 月期间随机选择的 75 例 ECU 收治患者的电子记录进行回顾性审计。收集基线时临床虚弱评分 （CFS） 、合并症、升级状态、APACHE II 疾病严重程度评分和结果测量的数据。结果 样本中的大多数患者，75 名患者中有 52 名 （69.3%），年龄在 65 岁以上，平均年龄为 69.1 岁。基线虚弱评分高，模态 CFS 为 6。在这些患者中，32 例 （61.5%） 有 DNACPR，17 例 （32.7%） 在 ECU 水平有治疗天花板。CFS 组之间的疾病严重程度相似，平均 APACHE II 评分为 15.2 分（代表 25% 的死亡风险）。65 岁以上的总体死亡率为 23.1% （12/52），按 CFS 分层时没有显着变化。65 岁以下的死亡率为 8.7% （2/23）。结论 急性虚弱患者可能受益于 ECU 级别的护理。在我们的中心，我们发现死亡率没有与较高的虚弱评分相关。我们认为，这可能代表了在处理虚弱方面经验丰富的临床医生的良好病例选择：收治具有更多可逆性的患者，并将治疗针对可逆原因。 局限性仍然存在，尤其是在评估疾病严重程度方面，因为评估工具不针对该队列。