Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Abstract

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.

Emergency Department Interventions for Older Adults: A Systematic Review

“…The field of geriatric emergency medicine continues to evolve rapidly. For instance, between the conclusion of our search and the peer review process of this article, an array of studies were published including a review of self‐defined geriatric EDs, a nurse transition intervention, and a pragmatic trial of an Australian‐based geriatric ED . Ongoing research is likely to result in additional articles in the near future, as evidenced by scientific abstracts presented at recent scientific meetings.…”

Safe to send home? Discharge risk assessment in the emergency department

“…29,39,40 Using an Observation Unit provides a setting and time for these assessments to occur without interrupting the flow of medical care in the ED. Comprehensive Geriatric Assessment (CGA) is a comprehensive and multidisciplinary review of social and health issues including cognitive function in order to develop a coordinated and integrated plan for treatment and longterm follow up.…”

“…Although generally time consuming, and considered by some an oxymoron for the ED environment, models have been developed for this to occur in the ED itself or in an ED co-located unit, such as an Observation Unit or Frailty Unit. 29,39,40 Using an Observation Unit provides a setting and time for these assessments to occur without interrupting the flow of medical care in the ED. [41][42][43] There is an experience with a co-located Emergency Frailty Unit that facilitates CGA including geriatric assessment and has been shown to reduce ongoing admissions and representations to ED.…”

“…Examples of this strategy include Aged Care Services in Emergency Teams nurses, transitional care nurses, and care coordination teams. 39,44,45 Other programmes use home assessment teams that will evaluate the patient within 24 h of the ED discharge. 46 In-person assessments seem to provide better outcomes than phone follow ups, as discharge follow up by telephone has not been • Have you discussed the level of care needed at home and whether carers will be available?…”

Improving care for older adults in the Emergency Department warrants greater investment in geriatric nursing—Stat!

“…For example, a study of a Transitional Care Nurse model, in which an ED nurse was trained to facilitate care transitions for older adults, reduced subsequent inpatient admissions by 5%À16%. 9 However, other studies have shown mixed results on the impacts of nurse-led interventions, demonstrating there is still more work to do to understand the best models of care. 10 As frontline providers, nurses offer a unique perspective on caring for older adults in the ED.…”