A Geriatric Emergency Department Evaluation Reduces Admissions and Decreases Hospital Length of Stay

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

Annals of Emergency Medicine

Abstract

Study Objectives: The older adult population, age 65 years, is steadily increasing in the United States and worldwide. Older adults are presenting to the emergency department (ED) more often and with more complex medical histories and comorbidities. These patients typically are more likely to be admitted and have longer ED and hospital lengths of stay (LOS). The goal of this study is to determine if the implementation of a Geriatric Emergency Medicine Assessment (GEMA) team as part of a Geriatric Emergency Department Accreditation consisting of trained Advanced Practice Providers (APPs), Occupation/Physical Therapists (OT/PT), and Care Management members, impacts overall admission rates and hospital LOS for geriatric patients. Methods: We investigated the impact of a GEMA team in a large tertiary care hospital ED from June 2021 to January 2023 during weekday hours, 8 a.m. to 6 p.m. The GEMA team was available to assess eligible patients 65 years who presented to the ED with an estimated severity index (ESI) of 2 during these hours. Eligible patients were screened by the GEMA team for increased risk of adverse functional outcomes and assessed for specific interventions including ED OT/PT evaluations, rehabilitation placement needs, delirium management evaluations, geriatric clinic referrals, and medication reconciliation/assessment specifically evaluating for polypharmacy. The control population included unassessed geriatric patients presenting to the ED during the study period. Inverse probability weighted (IPW) regression method was used to estimate the average assessment effects. Logistic regression generated a propensity score for each patient, which was then applied in an IPW regression to balance covariates of sex, race, ESI, Charlson Comorbidity Index, and payor type. The estimated results were reported with corresponding 95% confidence intervals (CI) and p-values for the regression analysis. All statistical tests were two-sided, and statistical significance was determined using a p-value threshold of less than 0.05. The analysis was conducted using R-4.3.1, provided by the R Foundation for Statistical Computing. Results: A total of 50,108 patients met inclusion criteria with a mean age of 77 +/- 8.5 years. Of these patients, 7,327 patients (6.8%) were assessed by the GEMA team with 60.7% of assessed patients being female, 69.6% white. The IPW regression analysis shows that assessed patients had significantly lower odds of hospital admission (OR:0.561; 95% CI: 0.532, 0.591; P< 0.001). The assessed patient admitted LOS decreased 24.11 hours compared to unassessed patients (OR:0.185; 95% CI: -0.208, -0.161; P<0.001). ED LOS for assessed patients was slightly higher, by 34.4 minutes, than that of unassessed patients with an estimate of 0.143 (95% CI: 0.126, 0.161; P<0.001). This trend was more noticeable among admitted patients (Figure 1). Using a Kaplan-Meier survival curve, assessed patients consistently demonstrate a higher cumulative probability of discharge compared to unassessed patients (Figure 2), suggesting that assessment by the GEMA team overall is associated with a higher likelihood of discharge from the ED and earlier hospital discharges if admitted. Conclusion: Patients assessed by the GEMA team in the ED are both less likely to be admitted to the hospital and if admitted, have an overall decreased hospital LOS. Together this supports prior research that dedicated Geriatric EDs and comprehensive geriatric assessments with subsequent targeted interventions are beneficial in reducing admissions and overall hospital LOS for geriatric patients. This has important patient care, cost savings, and hospital crowding implications.

Volume

84

Issue

4 Suppl 1

First Page

S21

Comments

American College of Emergency Physicians Research Forum, Sept 29- Oct 2, 2024, Las Vegas, NV

Last Page

S22

DOI

10.1016/j.annemergmed.2024.08.053

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