Risk of admission within 4 weeks of discharge of elderly patients from the emergency department—the DEED study

Caplan, Gideon A.; Brown, Ann; Croker, William; Doolan, Janis

doi:10.1093/ageing/27.6.697

Cited by 142 publications

(128 citation statements)

References 11 publications

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“…[1][2][3][4] Furthermore, they have a longer average length of stay and greater risks of adverse events, as functional decline, in-hospital death and rehospitalization after discharge. 1,3,[5][6][7] We previously showed that the elderly account for a high proportion of multiple hospital admissions. This fact is mainly as a result of poor health conditions, such as high comorbidity, presence of chronic multi-organ diseases and functional dependence.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

Fonte

Pivaro

et al. 2015

Geriatrics Gerontology Int

105

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Aim:To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods:The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.Results: Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases -resulting in 2637 days of prolonged hospital stay -and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Conclusions:Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314-321.

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Section: Introductionmentioning

confidence: 99%

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

Fonte

Pivaro

et al. 2015

Geriatrics Gerontology Int

105

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“…[4][5][6][7] Older patients are more likely to experience adverse events in the ED, 8 including iatrogenic injury, 9 missed diagnoses, 10 omitted treatments, [11][12][13] poor medical outcomes, 14,15 death, 16 functional decline, [17][18][19] prolonged stays, 16 necessity for a discharge to a higher level of care, 20 and repeat ED use. 21,22 A 1992 American study reported that EPs found it challenging to provide consistently high-quality care for older patients. 23 Improving the balance between rapid flow and optimal outcomes in the geriatric population may require both readjustment of the model of care for older adults 7 and disruptive innovation-beginning with geriatric emergency medicine education.…”

Section: Introductionmentioning

confidence: 99%

A national survey of Canadian emergency medicine residents’ comfort with geriatric emergency medicine

Snider

Melady

Costa

2016

CJEM

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Background: Geriatric patients represent a large and complex subgroup seen in emergency departments (EDs). Competencies in geriatric emergency medicine (EM) training have been established. Our objectives were to examine Canadian postgraduate year (PGY)-5 EM residents' comfort with the geriatric EM competency domains, assess whether Canadian EM residents become more comfortable through residency, and determine whether geriatric educational exposures are correlated with resident comfort with geriatric EM. Methods: A national, cross-sectional study of PGY-1 and PGY-5 Royal College EM residents was conducted to determine their comfort in geriatric EM clinical competency domains. Residents reported their level of comfort in satisfying each competency domain using a seven-point Likert scale. Residents were also asked about the location of their medical education as well as the type and number of different geriatric exposures that they had received to date. Results: Of the 141 eligible residents from across Canada, 77% (109) consented to participate. None of the PGY-1 EM residents and 34% (14) of PGY-5 EM residents reported that they were comfortable with all eight geriatric EM competency domains. PGY-5 EM residents were significantly more comfortable than PGY-1 EM residents. Residents reported a highly variable range of geriatric educational exposures obtained during training. No relationship was found between resident-reported comfort and the nature or number of geriatric exposures that they had received. Conclusion: Current Royal College EM residency training in Canada may not be adequately preparing graduates to be comfortable with defined competencies for the care of older ED patients.

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“…Patients who are not admitted as inpatients frequently suffer a deterioration in their condition, and up to 20% will re-present or be admitted within 1 month of discharge. 4 Those who are discharged home from the ED often express apprehension about their ability to manage after discharge. 3 In a study of ED usage by older Australians, Richardson reported that one of the strongest predictors of death or increased dependency within 3 months of discharge was found in presentations where social factors were of concern.…”

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confidence: 99%

Care coordination in the Emergency Department: improving outcomes for older patients

Corbett

Lim²,

Davis³

et al. 2005

Aust. Health Review

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This study aimed to evaluate the effectiveness of the care coordination (CC) program operating in the Emergency Department (ED) of The Northern Hospital in improving outcomes for older people and reducing ED admissions and re-presentations. This was achieved by comparing admissions from ED to wards pre and post commencement of the CC program, and measuring patient health-related quality of life pre and post CC intervention. Patient readmission rates and staff and patient satisfaction with the service were also investigated. Results indicate a statistically significant reduction in the proportion of patients admitted from the ED to a ward since the inception of the program, a significant difference in the mean-related quality of life scores before and after intervention by care coordination, and staff and patient satisfaction with the service. The readmission data collected in the present evaluation will serve as a baseline meas- CONTINUING DEMANDS ON ACUTE CARE hospitals have resulted in an increased delay in admission of emergency patients to ward beds, blocking of emergency departments (EDs), and an increase in ambulance bypass. 1 Older patients are often believed to cause "access block" due to the frequent need to admit them to hospital for reasons other than those that are purely medical. A shortage of available placements in aged care facilities and a lack of home support or other social issues are often the impetus for admission following a relatively minor injury or illness. 2 In 1996, Street and colleagues 3 reported on the complex issues surrounding presentation and discharge of older people from the hospital ED. They noted the difficulties of presentations where symptoms were sometimes non-specific, or where complex issues were compounded by disability and confusion. Patients who are not admitted as inpatients frequently suffer a deterioration in their condition, and up to 20% will re-present or be admitted within 1 month of discharge. 4 Those who are discharged home from the ED often express apprehension about their ability to manage after discharge. 3 In a study of ED usage by older Australians, Richardson reported that one of the strongest predictors of death or increased dependency within 3 months of discharge was found in presentations where social factors were of concern. What does this paper add?A multi-disciplinary case management approach supported by brokerage funds was effective in reducing the admission rate of patients presenting to the Emergency Department of a metropolitan hospital. What are the implications?While this model is successful, further evaluation of the many approaches currently being trialled in Australia is needed.

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Risk of admission within 4 weeks of discharge of elderly patients from the emergency department—the DEED study

Cited by 142 publications

References 11 publications

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

A national survey of Canadian emergency medicine residents’ comfort with geriatric emergency medicine

Care coordination in the Emergency Department: improving outcomes for older patients

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