Vital signs are essential for monitoring and prognostication in the emergency department (ED); however, they may not fully capture the complexity of frailty in older adults. In this multicenter retrospective study of 932 older patients who visited the EDs of three tertiary university hospitals between August 1 and October 31, 2023, we investigated the prognostic value of the Clinical Frailty Scale (CFS) in older patients in the ED and its potential to improve existing vital sign-based scoring systems. The primary outcomes were hospital admission, intensive care unit (ICU) admission, and in-hospital mortality. The AUROC was used to evaluate and compare the predictive performance of CFS, qSOFA, NEWS2, and REMS scores individually and in combination. Combining the CFS with these scores significantly improved predictive accuracy compared to individual scores alone. For hospital admission, the AUROCs were 0.715 (95% CI 0.685–0.744), 0.723 (95% CI 0.693–0.752), and 0.688 (95% CI 0.657–0.718) for CFS + qSOFA, CFS + NEWS2, and CFS + REMS, respectively. For ICU admission, the AUROCs were 0.730 (95% CI 0.701–0.759), 0.714 (95% CI 0.684–0.743), and 0.707 (95% CI 0.677–0.736), respectively. For in-hospital mortality, the AUROCs were 0.798 (95% CI: 0.771–0.823), 0.774 (95% CI: 0.746–0.801), and 0.819 (95% CI: 0.793–0.843), respectively, indicating excellent performance. Incorporating frailty assessment using the CFS enhances risk stratification in older patients in the ED by complementing vital sign-based scores. This provides a more comprehensive assessment, enabling better informed clinical decisions. This study supports employing routine frailty assessment in the ED and the development of enhanced risk stratification tools that incorporate frailty.

Occupational stress can have a harmful effect on the individual both physically and psychologically. In Korea, occupational stress of physician is rarely demonstrated. Although it is well reported that physicians tend to have a high incidence of minor psychiatric disorders, the magnitude of the problem remains unclear. Interns and residents are thought to be under substantial amount of stress, and tend to have psychiatric disorder. In this paper, we aimed to evaluate the relationship between the occupational stress and depression of residents. The participants of this study were surgical and medical residents in a tertiary hospital in Korea. For measurement of occupational stress, we used an occupational stress scale. In addition, to evaluate the prevalence of depression, we used the Beck Depression Inventory. Female doctors showed higher degree of occupational stress than the males. The interns and chief residents showed higher degree of occupational stress than the other residents. Interestingly, in this study, most of the participants experienced a depressive mood. Compared with the general population, job demand and culture of workplace were high. Occupational stress was the only significant predictor of a depressive mood. Hospital residents experience a high degree of occupational stress leading to a depressed mood due to various risk factors. Therefore, it is essential to recognize the occupational stress of residents early, to encourage positive competition and peer and social support, and to help improve the residents' ability to cope with stress.

Background and Objectives: The Clinical Frailty Scale (CFS), used to screen for prehospital frailty in patients aged >65 years, is simple, time-efficient, and has been validated in emergency departments (EDs). In this study, we analyzed whether the Korean Triage and Acuity Scale (KTAS) classification by level in older patients determined to have frailty based on the Korean version of the CFS increases the triage performance of the current KTAS. Materials and Methods: The primary outcome was 30-day in-hospital mortality, and secondary outcomes were hospital and intensive care unit (ICU) admissions. This study retrospectively analyzed prospectively collected data from three ED centers. Patients with a CFS score ranging from five (mildly frail) to nine (terminally ill) were categorized into the frailty group. We upgraded the KTAS classification of the frailty group by one level of urgency and defined this as the CFS-KTAS. Results: The cutoff values for predicting admission were three and two for the KTAS and CFS-KTAS, respectively. A significant difference was observed in the area under the receiver operating characteristic (AUROC) curve between the KTAS and CFS-KTAS. To predict ICU admission, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. For predicting in-hospital mortality, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. Conclusions: This study showed that the CFS-adjusted KTAS has a more useful prognostic value than the KTAS alone for predicting hospital outcomes in older patients.

The aims of this study were to investigate the reasons of transfers from long-term care hospitals (LTCHs) to emergency departments (EDs) of university hospitals in geriatric patients and to categorize the avoidable causes of these transfers. This retrospective multicenter study involved patients aged 65 years and older who were transferred from LTCHs to 5 EDs of university hospitals located in the metropolitan area of South Korea between January 2017 and December 2017. The expert panel reviewed and categorized the reason of transfers as avoidable or not. Moreover, we also investigated the number of patients with do-not-resuscitate (DNR) documents and the date these DNR documents were written. A total of 255,543 patients visited 5 EDs during the study period. Of these, 1,131 patients were from LTCHs. The number of potentially avoidable transfers was 168/1,131 (14.9%). The most common reason of avoidable transfers was noncritical diagnoses that could be assessed and managed in LTCHs (57.1%). There were 162 patients with DNR orders; of these, 12 had approved the DNR order before transfer. In conclusion, in Korea, potentially avoidable transfers could be reduced by managing noncritical diseases in LTCH and preparing advance care directives, including DNR orders, during admission to LTCH.