Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study
Abstract Background Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frai...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-021-02044-w |
| _version_ | 1818417521269669888 |
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| author | Jenny Liu Therese Palmgren Sari Ponzer Italo Masiello Nasim Farrokhnia |
| author_facet | Jenny Liu Therese Palmgren Sari Ponzer Italo Masiello Nasim Farrokhnia |
| author_sort | Jenny Liu |
| collection | DOAJ |
| description | Abstract Background Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frail patients, and the weak evidence of positive outcomes of using CGA in EDs pose barriers to introduce the guidelines. Dedicating an interprofessional team of regular ED medical and nursing staff and an older-friendly ED area can be another approach. Previous studies of geriatrician-led CGA in EDs have reported a reduced hospital admission rate. The aim of this study was to investigate whether a dedicated interprofessional emergency team also can reduce the hospital admission rate without the resources required by the formal use of CGA. Methods An observational pre-post study at a large adult ED, where all patients 80 years or older arriving on weekdays in the intervention period from 2016.09.26 to 2016.11.28 and the corresponding weekdays in the previous year from 2015.09.28 to 2015.11.30 were included. In the intervention period, older patients either received care in the geriatric module by the dedicated team or in the regular team modules for patients of mixed ages. In 2015, all patients received care in regular team modules. The primary outcome measure was the total hospital admission rate and the ED length of stay was the secondary outcome measure. Results We included 2377 arrivals in the intervention period, when 26.7% (N = 634) received care in the geriatric module, and 2207 arrivals in the 2015 period. The total hospital admission rate was 61.7% (N = 1466/2377) in the intervention period compared to 64.8% (N = 1431/2207) in 2015 (p = 0.03). The difference was larger for patients treated in the geriatric module, 51.1% compared to 62.1% (95% CI: 56.3 to 68.0%) for patients who would have been eligible in 2015. The ED length of stay was longer in the intervention period. Conclusions An interprofessional team and area dedicated to older patients was associated to a lower hospital admission rate. Further studies are needed to confirm the results. |
| first_indexed | 2024-12-14T12:08:06Z |
| format | Article |
| id | doaj.art-69e7a14151d6410b90b68e6bbbb49dd4 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-14T12:08:06Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-69e7a14151d6410b90b68e6bbbb49dd42022-12-21T23:01:50ZengBMCBMC Geriatrics1471-23182021-02-012111810.1186/s12877-021-02044-wCan dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention studyJenny Liu0Therese Palmgren1Sari Ponzer2Italo Masiello3Nasim Farrokhnia4Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖSDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖSDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖSDepartment of Computer Science and Media Technology, Linnaeus UniversityDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖSAbstract Background Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frail patients, and the weak evidence of positive outcomes of using CGA in EDs pose barriers to introduce the guidelines. Dedicating an interprofessional team of regular ED medical and nursing staff and an older-friendly ED area can be another approach. Previous studies of geriatrician-led CGA in EDs have reported a reduced hospital admission rate. The aim of this study was to investigate whether a dedicated interprofessional emergency team also can reduce the hospital admission rate without the resources required by the formal use of CGA. Methods An observational pre-post study at a large adult ED, where all patients 80 years or older arriving on weekdays in the intervention period from 2016.09.26 to 2016.11.28 and the corresponding weekdays in the previous year from 2015.09.28 to 2015.11.30 were included. In the intervention period, older patients either received care in the geriatric module by the dedicated team or in the regular team modules for patients of mixed ages. In 2015, all patients received care in regular team modules. The primary outcome measure was the total hospital admission rate and the ED length of stay was the secondary outcome measure. Results We included 2377 arrivals in the intervention period, when 26.7% (N = 634) received care in the geriatric module, and 2207 arrivals in the 2015 period. The total hospital admission rate was 61.7% (N = 1466/2377) in the intervention period compared to 64.8% (N = 1431/2207) in 2015 (p = 0.03). The difference was larger for patients treated in the geriatric module, 51.1% compared to 62.1% (95% CI: 56.3 to 68.0%) for patients who would have been eligible in 2015. The ED length of stay was longer in the intervention period. Conclusions An interprofessional team and area dedicated to older patients was associated to a lower hospital admission rate. Further studies are needed to confirm the results.https://doi.org/10.1186/s12877-021-02044-wEmergency departmentOlder patientsHospital admissionLength of stayInterprofessionalTeamwork |
| spellingShingle | Jenny Liu Therese Palmgren Sari Ponzer Italo Masiello Nasim Farrokhnia Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study BMC Geriatrics Emergency department Older patients Hospital admission Length of stay Interprofessional Teamwork |
| title | Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study |
| title_full | Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study |
| title_fullStr | Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study |
| title_full_unstemmed | Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study |
| title_short | Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study |
| title_sort | can dedicated emergency team and area for older people reduce the hospital admission rate an observational pre and post intervention study |
| topic | Emergency department Older patients Hospital admission Length of stay Interprofessional Teamwork |
| url | https://doi.org/10.1186/s12877-021-02044-w |
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