To date, there have been no studies looking at potential harms that may occur when patients are admitted with a diagnosis of FTT and associated labels. An earlier retrospective cohort study hypothesized that acute medical illness rather than social factors is the primary reason for admission for patients labeled as FTT, as the majority of patients in this study received an extensive medical workup and interventions such as intravenous fluids and antibiotics. Studies have also suggested that labels are powerful in the healthcare setting and may alter how patients are perceived. It has been postulated that FTT and “failure to cope” are being used as labels of expediency to imply predominantly social issues, rather than medical issues, as the reason for admission. Observational studies have shown that the emphasis on wait times and speed of patient flow as part of a “performance management approach” in resource allocation have shifted importance to efficiency rather than safe, patient-centered care. Concurrently, emergency department (ED) wait times, allocation of hospital resources, and the evolution of interdisciplinary care are at the forefront of healthcare discussions. The prevalence of FTT and related terms has not been quantified, however there has been a general trend of an increasing number of older adults presenting to healthcare, as their prevalence increases in the general population. Despite the wide range of symptoms the term encompasses, and the lack of consensus in its definition, the term has been adopted into the International Classification of Diseases, Ninth Revision (ICD-9) since 1979 and continues to be commonly used in clinical practice. This term was adopted from pediatrics in the 1970’s, and over the years, has come to represent a syndrome of vague symptoms among older adults that includes unexplained loss of appetite, weight loss, cognitive and functional decline, and social isolation, complicated by multiple medical comorbidities and psychiatric factors. “Failure to thrive”, or FTT, is a nonspecific term commonly applied to older adults in the emergency room when there is uncertainty over the cause of their presentation to hospital. The use of this non-specific label can lead to premature diagnostic closure and should be avoided in clinical practice. Patients with an admission diagnosis of FTT or other associated diagnoses had significant delays in care when presenting to the emergency room, despite often having acute medical conditions on presentation. Patients in this cohort stayed 18.3 days in hospital compared to 10.2 days ( p = .001). Notably, 88% of the “failure to thrive” cohort had an acute medical diagnosis at the time of discharge. Concordance of admission and discharge diagnoses was only 12% for the “failure to thrive” cohort, and 95% for controls. The total time from triage to admission for older adults admitted with FTT and associated diagnoses was 10 h 40 min, compared to 6 h 58 min for controls ( p = .02). Secondary outcomes were concordance of admission and discharge diagnoses and length of stay in hospital. The primary outcome was time to admission, measured from time points in the emergency room that spanned from triage to completion of admission orders. Age-matched controls met the same inclusion criteria with admission diagnoses other than those of interest ( n = 60, median age 79 years). Cases identified were adults aged ≥65 years admitted to acute medical wards with an admission diagnosis of “failure to thrive”, “FTT”, “failure to cope”, or “FTC”, between Januand Novem( n = 60, median age 80 years). Retrospective matched cohort study conducted at a tertiary care hospital in Vancouver, BC. We investigated the effect of such admission diagnoses on delivery of patient care in a cohort of older adults admitted to a tertiary care teaching hospital. “Failure to thrive” and associated diagnoses are non-specific terms applied to older adults when there is lack of diagnostic clarity and imply an absence of medical acuity.
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