The emergency to home project: impact of an emergency department care coordinator on hospital admission and emergency department utilization among seniors

Bond, Christopher; Freiheit, Elizabeth; Podruzny, Lesley; Kingsly, Alianu Akawakun; Wang, Dongmei; Davenport, Jamie; Gutscher, A.; Askin, Cathy; Taylor, Allison; Lee, Vivian; Choo, Queenie; Lang, Eddy

doi:10.1186/1865-1380-7-18

Cited by 12 publications

(12 citation statements)

References 14 publications

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“…A total of 2000 citations were identified from a combined search of databases, reviewing bibliographies of relevant review articles, and targeted searches of http://clinicaltrials.gov and Scopus. After applying eligibility criteria, 17 articles describing 15 studies, nine randomized and six nonrandomized were included (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies, two randomized, examined the effect of ED interventions on hospitalization at the index ED visit . Overall, there was no pattern of interventions on hospitalization at the index visit.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies, five randomized, reported effects of ED interventions on hospitalization after the index ED visit . Five evaluated multi‐strategy interventions, two of which included all three intervention components …”

Section: Resultsmentioning

confidence: 99%

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Emergency Department Interventions for Older Adults: A Systematic Review

Hughes

Freiermuth

Shepherd‐Banigan

et al. 2019

J American Geriatrics Society

109

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OBJECTIVES To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN A conceptual model informed, protocol‐based systematic review. SETTING Emergency Department (ED). PARTICIPANTS Older adults 65 years of age and older. METHODS AND MEASUREMENT Medline, Embase, CINAHL, and PsycINFO were searched for English‐language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi‐strategy) and key intervention components present (ie, assessment, referral plus follow‐up, and contact both before and after ED discharge [“bridge”]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated. RESULTS A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit. CONCLUSION Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Emergency Department Interventions for Older Adults: A Systematic Review

Hughes

Freiermuth

Shepherd‐Banigan

et al. 2019

J American Geriatrics Society

109

View full text Add to dashboard Cite

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“…While we did not compare ED revisits with non-fall patients, our revisit findings are within the wide range of overall older adult ED revisit rates and similar to a recent study reporting a 30-day ED revisit rate among fallers of 13.6%. 18 McCusker's study of patients aged 65 and above who were discharged from the ED found 19.3% of patient made an ED revisit within 30 days and over 40% within 6 months. 19 Friedmann's single site cohort study of elderly patients who were discharged from the ED found a 12% revisit rate at 30 days among older adult ED discharged patients and a 19% ED revisit rate at 90 days.…”

Section: Discussionmentioning

confidence: 99%

Frequency of ED revisits and death among older adults after a fall

Liu

Obermeyer

Chang

et al. 2015

The American Journal of Emergency Medicine

104

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Introduction Falls among older adults (aged ≥65 years) are the leading cause of both injury deaths and emergency department (ED) visits for trauma. We examine the characteristics and prevalence of older adult ED fallers as well as the recurrent ED visit and mortality rate. Methods This was a retrospective analysis of a cohort of elderly fall patients who presented to the ED between 2005 and 2011 at two urban, level-1 trauma, teaching hospitals with approximately 80,000-95,000 annual visits. We examined the frequency of ED revisits and death at 3 days, 7 days, 30 days, and 1 year controlling for certain covariates. Results Our cohort included 21,340 patients. The average age was 78.6. An increasing proportion of patients revisited the ED over the course of a year, ranging from 2% of patients at 3 days to 25% at 1 year. Death rates increased from 1.2% at 3 days to 15% at 1 year. 10,728 (50.2%) patients returned to the ED at some point during our 7-year study period and 36% of patients had an ED revisit or death within 1 year. In multivariate logistic regression, male sex and comorbidities were associated with ED revisits and death. Conclusion Over a third of older adult ED fall patients had an ED revisit or died within one year. Falls are one of the geriatric syndromes that contribute to frequent ED revisits and death rates. Future research should determine whether falls increase the risk of such outcomes and how to prevent future fall and death.

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“…Although a modest positive effect was shown in reducing unscheduled revisits, again this study population consisted exclusively of patients that were discharged from the ED. In a study by Gagnon et al, nurse case management of elderly patients discharge from the ED resulted in higher rates of ED readmission, with no improvement in other outcomes [16]. In all of these studies, seniors were discharged from the ED on the index visit, and all enrolled patients were community-dwelling and not institutionalized.…”

Section: Discussionmentioning

confidence: 99%