TREAT — emergency admission avoidance for older people
Lay summary
TREAT (Triage and Rapid Elderly Assessment Team) was founded at the Royal Free Hospital in September 2010 to reduce avoidable emergency admissions for older people. Dr Wright joined the team shortly after it was founded and led its first formal evaluation. Embedded in the emergency department, the team pairs a geriatrician with a senior nurse and access to community therapy services. Their job is to identify which patients aged 70 and over arriving at A&E can be safely managed without an overnight admission — either by arranging same-day discharge with community follow-up, or by referring directly to specialist outpatient care.
Dr Wright was first author of the evaluation published in Age & Ageing in 2014, looking at TREAT's first year of operation. The findings: across 593 admissions accepted by TREAT, 32% were discharged on the day of admission, with a median length of stay of one day. Length of stay across all emergency geriatric admissions at the hospital fell by 11.65%, and by 18.16% for the patients TREAT touched directly.
The study is widely cited and has informed similar service designs at other NHS Trusts. Avoidable hospital stays for older people are expensive for the NHS and often suboptimal for the patient — TREAT shows what a geriatrician-led service in the emergency department can change.
What it is
TREAT is an emergency-department-embedded geriatric admission-avoidance service. A geriatrician, senior nurse, and access to community therapy resources work together to identify older patients in A&E who can be safely managed without an acute overnight admission. The pathway either expedites same-day discharge with community follow-up arranged, or refers the patient directly to specialist outpatient care.
Why it matters
NHS data shows that older patients account for around 40% of hospital admissions and 60% of bed-days. Avoidable admissions are costly to the system and often suboptimal for the patient — disrupting daily routines, raising delirium risk, and prolonging recovery. The TREAT evaluation provides one of the better-controlled accounts in the geriatric literature of what a geriatrician-led service in the emergency department can actually change. Similar service designs at other NHS Trusts have been informed by this work.
Citation
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Companion content
- Trick or TREAT — BGS blog (Oct 2013)
- RSM Trainees' Prize Platform Presentation runner-up (Jun 2013)