Academic Emergency Medicine
Background and Objectives: Older adult patients admitted to the hospital from the Emergency Department (ED) have a longer length of stay in the hospital on average compared to younger patients. Geriatric patients make up an increasing percentage of the patient population, and almost all health care for geriatric patients in the United States is paid for by Medicare. The cost of the inpatient care of geriatric patients is a significant contributor to the total cost of health care in the United States. Methods: We conducted a case-control study looking at the impact of a Geriatric Emergency Medicine Assessment (GEMA) team on hospital length of stay and associated cost savings. The GEMA team consisted of an advanced practice provider and dedicated care manager who assessed patients over the age of 65 who presented to the Emergency Department and provided targeted interventions based on the results of their assessment. Data on assessed patients who presented from November 2019 through October 2020 were collected prospectively and compared to geriatric patients who presented to the ED during this time frame and who did not undergo GEMA assessment using a retrospective chart review. The cost of the hospital length of stay was calculated using the hospital-specific average cost for one day of an inpatient stay. Results: From November 2019 through October 2020, an average of 258 patients were assessed by the GEMA team per month, with a monthly average of 141 admissions. GEMA assessed patients had a hospital length of stay that was 31 hours shorter than nonGEMA patients. Using the average cost of a 24-hour inpatient stay in our hospital, we calculated that $273,188 was saved per month. Subtracting the cost of our program, this resulted in a total cost savings of $3,017,166 per year. Conclusion: A geriatric-focused assessment and targeted intervention in the Emergency Department results in a significantly shorter hospital length of stay for assessed patients, resulting in substantial cost savings. This provides evidence for the financial feasibility of targeted geriatric intervention programs in the Emergency Department.
Keene S, Cameron-Comasco L. Geriatric emergency medicine assessment in the emergency department results in yearly savings of $3 million. Acad Emerg Med. 2021 May;28(suppl 1):S250.