Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department

Abstract

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation.

Response to Outcomes in older patients requiring comprehensive allied health care prior to discharge from the emergency department: Reply

“…We agree, and have shown previously, 3 that a number of geriatric syndromes such as frailty, and clinical associations with ageing like polypharmacy, are increasingly important in the assessment of older people especially as they relate to discharge risk.…”

Is China facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases?

“…To use medical health resources in an effective manner, a few developed countries, such as the United Kingdom and the United States, have begun to improve discharge planning processes for elderly patients with chronic diseases to avoid the further deterioration of health caused by these diseases and to reduce rehospitalization costs. [43][44][45] However, hospital nurses in China generally lack knowledge of continuity of care, and fewer nursing services are being developed for elderly patients after their discharge from community health service centres. 30 This gap in care also increases the probability of rehospitalization in the same population.…”

Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data

“…Although acute illness or acute exacerbation of chronic illness is a precipitating factor for ED presentation, it often overlays a plethora of hidden psychosocial issues in older patients. Anxiety, feeling depressed, lack of social support and cognitive impairment have been identified as predictors of return visits; alongside prior ED presentation and previous hospitalisation . It is recognised that the fast‐paced nature of the ED environment is not always conducive to assessment beyond the primary medical reason for presentation.…”