The Acute Care assessment system, or interRAI AC, was developed to identify older and disabled people admitted to acute hospitals with conditions that may benefit from comprehensive specialist assessment. The interRAI AC, released in March 2006, covers a wide range of clinical domains with 96 standardized assessment items. Assessments are carried out on two occasions. Within 48 hours of admission, the individual's pre-hospital admission status and the status early in the hospital stay are recorded. A second assessment is made late in the hospital stay (within 24-48 hours of discharge) to identify residual problems which require post hospital follow up, and to facilitate outcome assessment. Review assessments can be conducted during the stay when there is a significant change in status or when important discharge decisions are under consideration.

Target population

Older or disabled people admitted to any acute hospital service for in-patient treatment who are targeted to receive comprehensive assessment. The instrument is suited to acute geriatric assessment units, geriatric consultation services and for targeted use in general medical and surgical wards.

Adoption and Use

The purpose of the AC is to support effective assessment of older people admitted to acute hospital services so that common geriatric syndromes, functional and psychosocial problems that would benefit from treatment are not overlooked, and to support discharge planning that addresses identified issues. The interRAI AC has been designed for completion by physicians (interns, house officers), nurses or other staff, depending on the organization of services within each facility. Initial assessments require 20 to 90 minutes for completion. However, the interRAI AC reduces the need for other assessment and screening tools, and thus if carefully applied can reduce overall service cost. Field testing of the interRAI AC in 9 countries demonstrated excellent inter-rater reliability for both pre-morbid and admission item sets.

• Identification Information
• Intake and Initial History
• Assessment Dates
• Cognition
• Communication and Vision
• Mood and Behaviour 
• Health Conditions
• Oral and Nutritional Status
• Skin Condition
• Medications
• Treatments and Procedures
• Responsibilities and Directives 

 
The routine use of the interRAI AC can assist in care planning during the hospital stay, in triage of acute admissions for referral to a geriatric service and to facilitate timely planning for follow-up services post-discharge. The instrument can also be used to provide information to the next care setting beyond discharge. The interRAI AC shares many common items with other interRAI assessment instruments, with the majority of its items being found in the interRAI HC and interRAI LTCF.

A strength of the instrument is its ability to characterize differences in the patient’s admission and pre-morbid function. This underpins accurate prognostication required for planning post-acute and rehabilitation services. The “admission” profile section of the instrument is also suitable for application to geriatric consultation services.

The interRAI AC incorporates screeners for dementia, delirium, depression and malnutrition. It includes a range of scalar measures that enable rapid assessment of severity or dependency in the domains of cognition, communication, personal and instrumental ADL and pain. There are inbuilt risk assessment tools for falls, delirium, functional decline and pressure ulcer. The instrument can thus perform the task of a range of syndrome specific instruments. It is designed to reduce documentation burden associated with an increasing array of screening tasks.

Languages Available

• English
• Finnish
• Icelandic
• Italian
• Norwegian
• Spanish

Ongoing Development

A range of projects is underway to further validate the screening and risk assessment protocols within the interRAI AC, and to develop quality indicators and case-mix tools.

The targeted use of the interRAI AC in mixed ward settings where geriatric and disabled patients are in the minority requires a screening strategy. Research is currently in progress to develop a screener (for comprehensive assessment) for application in these settings. The screener would be applied in emergency departments or upon arrival at the ward.

Older patients are frequent visitors to emergency rooms. Safe, well executed discharge direct from the emergency room requires an assessment of ongoing needs and risks. Studies are in progress to develop an emergency room screener to support this task.

Baseline Research Publications

Carpenter GI, Teare GF, Steel K, Berg K, Murphy K, Bjornson J, Jonsson PV, Hirdes JP. (2001) A new assessment for elders admitted to acute care: reliability of the MDS-AC, Aging Clin. Exp. Res:13;316-330

Research and Development Team

Len Gray (Chair) The University of Queensland (Australia)
Katherine Berg, McGill University, (Canada)
Roberto Bernabei, Università Cattolica del Sacro Cuore (Italy)
Sergio Blasco, Hospital General of Granollers (Spain)
Harriet Finne-Soveri (Finland)
Brant Fries, University of Michigan (USA)
John Hirdes, University of Waterloo (Canada)
Palmi Jonsson, Reykjavik Hospital (Iceland)
John Morris, Hebrew Rehabilitation Center for Aged (USA)
Sue Nonemaker, Hebrew Rehabilitation Center for Aged (USA)
Katherine Murphy, Hebrew Rehabilitation Center for Aged (USA)
Terry Rabinowitz, Fletcher Allen Health Care (USA)
Knight Steel, Hackensack University Medical Center (USA)
Eva Topinková, Charles University and Institute of Postgraduate Medical Education (Czech Republic)

For further information, please contact:

Professor Len Gray, Academic Unit in Geriatric Medicine, The University of Queensland, Australia. 
Email: len.gray@uq.edu.au