INTERVENTION:The intervention was first TCN contact. Controls never saw a TCN during the study period. MEASUREMENTS: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0-30) and 72-hour ED revisits. RESULTS: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: À9.9% risk of inpatient admission, 95% confidence interval (CI) = À12.3% to À7.5%; site 2: À16.5%, 95% CI = À18.7% to À14.2%; site 3: À4.7%, 95% CI = À7.5% to À2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7-2.3%; site 2: 1.4%, 95% CI = 0.7-2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: À7.8%, 95% CI = À10.3% to À5.3%; site 2: À13.8%, 95% CI = À16.1% to À11.6%). CONCLUSION: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission. J Am Geriatr Soc 2018.

ICU admission decisions for critically ill emergency department patients are affected by medical ICU bed availability, though higher emergency department volume and other ICU occupancy did not play a role. Prolonged emergency department boarding times were associated with worse patient outcomes, suggesting a need for improved throughput and targeted care for patients awaiting ICU admission.

IMPORTANCE There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers. OBJECTIVE To evaluate the association of GED programs with Medicare costs per beneficiary.

ObjectivesTransitional care nurse (TCN) care has been associated with decreased hospitalizations for older adults in the emergency department (ED). The objective of this study was to evaluate the association between TCN care and readmission for geriatric patients who visit the ED within 30 days of a prior hospital discharge.MethodsWe studied a prospective cohort of ED patients aged 65 and older with an ED visit within 30 days of inpatient discharge. Patients with an Emergency Severity Index of 1 or prior TCN contact were excluded. Entropy balancing and logistic regression were used to estimate the average incremental effect of the TCN intervention on risk of admission during the index ED visit and within 30 days of prior discharge.ResultsOf 6,838 visits, 608 included TCN care. TCN patients had lower risk of readmission during the index ED visit at Mount Sinai Medical Center (MSMC), −10.1 percentage points (95% confidence interval [CI] = −18.5 to −2.7), and Northwestern Memorial Hospital (NMH), −17.3 percentage points (95% CI = −23.1 to −11.5), but not St. Joseph’s Regional Medical Center (SJRMC), −2.5 percentage points (95% CI = −10.5 to 5.5). TCN patients had fewer readmissions within 30 days of prior hospital discharge at NMH, −16.2 percentage points (95% CI = −22.0 to −10.3), but not at MSMC, −5.6 percentage points (95% CI = −13.1 to 1.8), or at SJRMC, 0.5 percentage points (95% CI = −7.2 to 8.2).ConclusionsTransitional care nurse care in the ED after a prior hospitalization was associated with decreased readmission of older adults during the index ED visit at two of three hospitals, with sustained reduction for the entire 30‐day readmission window at one hospital. TCN interventions in the ED may decrease readmissions for geriatric patients in the ED; however, these results may be dependent on implementation of the program and availability of ED, hospital, and local resources for older adults.

Background and Aims Increased alcohol consumption has been proposed as a potential consequence of the coronavirus disease 2019 (COVID‐19) pandemic. There has been little scrutiny of alcohol use behaviors resulting in hospital visits, which is essential to guide pandemic public policy. We aimed to determine whether COVID‐19 peak restrictions were associated with increased hospital visits for alcohol use or withdrawal. Secondary objectives were to describe differences based on age, sex and race, and to examine alcohol‐related complication incidence. Design Multi‐center, retrospective, pre–post study. Setting New York City health system with five participating hospitals. Participants Adult emergency department encounters for alcohol use, alcoholic gastritis or pancreatitis or hepatitis, alcohol withdrawal syndrome, withdrawal seizure or delirium tremens. Measurements Age, sex, race, site and encounter diagnosis. Encounters were compared between 2019 and 2020 for 1 March to 31 May. Findings There were 2790 alcohol‐related visits during the 2019 study period and 1793 in 2020, with a decrease in total hospital visits. Of 4583 alcohol‐related visits, median age was 47 years, with 22.3% females. In 2020 there was an increase in percentage of visits for alcohol withdrawal [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.07–1.67] and withdrawal with complications (aOR = 1.40, 95% CI = 1.14–1.72), and a decline in percentage of hospital visits for alcohol use (aOR = 0.70, 95% CI = 0.59–0.85) and use with complications (aOR = 0.71, 95% CI = 0.58–0.88). It is unknown whether use visit changes mirror declines in other chief complaints. The age groups 18–29 and 60–69 years were associated with increased visits for use and decreased visits for withdrawal, as were non‐white race groups. Sex was not associated with alcohol‐related visit changes despite male predominance. Conclusions In New York City during the initial COVID‐19 peak (1 March to 31 May 2020), hospital visits for alcohol withdrawal increased while those for alcohol use decreased.