308 A Geriatric Emergency Medicine Assessment Team Reduces Hospital Length of Stay through Faster Discharge to Subacute Rehabilitation

Abstract

BackgroundPatients aged 65 years of older are more likely to have longer hospital length of stays (LOS) than younger patients. Previously, we described the implementation of a Geriatric Emergency Medicine Assessment (GEMA) team that assesses older adults in the emergency department (ED) and provides appropriate interventions. In a pre-post study, we found that GEMA assessment was associated with a 25- hour reduction in hospital LOS.Study ObjectivesUsing a case-control design on data collected from the first two years after implementation, we sought to quantify the reduction in hospital LOS and further elucidate the causes of this reduced time in the hospital.MethodsOur GEMA team consists of an advance practice provider who screens ED patients ≥65 years old for functional decline. If patients screen positive, additional assessments are performed, which can trigger interventions such as occupational therapy (OT) assessment in the ED. Here, we performed a nested case- control study from a larger cohort of patients consisting of all patients ≥65 years of age who presented to the ED between October 2019 and December 2021 and who were subsequently admitted to the hospital (n=34,412). Patients who were admitted to the intensive care unit or to the observation unit were excluded. Cases were designated as those patients who underwent GEMA assessment. Controls were patients who were not assessed by the GEMA team and were matched to cases in a 1:4 ratio, with replacement, based on the criteria age, sex, race, and Estimated Severity Index (ESI). Data was obtained by retrospective chart review.ResultsThere were 3,019 cases and 8,379 controls. The mean hospital LOS was 23 hours shorter for cases compared to controls (5.74 d vs 6.69 d; p<0.001). Cases were more likely to be discharged home after admission than to a subacute rehabilitation facility (SAR) (OR 1.22, 95% CI 1.08-1.33). For patients who were discharged home after admission, the mean difference in LOS was 11 h (4.64 d vs 5.10 d; p<0.001), and for patients who were discharged to a SAR after admission, the mean difference in LOS was 30 h (8.44 d vs 9.67 d; p=0.002). Patients who underwent OT assessment in the ED via the GEMA program and who were subsequently discharged to SAR after hospital admission had a reduction in LOS of 37 h (8.13 d vs 9.66 d; p=0.007).ConclusionGEMA patients had a shorter hospital LOS than matched controls and were more likely to be discharged home. The greatest difference in hospital LOS was found in patients who were discharged to a SAR after hospital admission and for whom GEMA assessment had resulted in OT assessment in the ED. This implies that the difference in hospital length of stay is primarily driven by two factors: 1) an increased number of patients who are able to be discharged home; and 2) the early involvement of OT in patients discharged to SAR. Additional contributors to the decreased LOS, such as a reduction in the incidence of delirium, remain to be investigated.No, authors do not have interests to disclose BackgroundPatients aged 65 years of older are more likely to have longer hospital length of stays (LOS) than younger patients. Previously, we described the implementation of a Geriatric Emergency Medicine Assessment (GEMA) team that assesses older adults in the emergency department (ED) and provides appropriate interventions. In a pre-post study, we found that GEMA assessment was associated with a 25- hour reduction in hospital LOS. Patients aged 65 years of older are more likely to have longer hospital length of stays (LOS) than younger patients. Previously, we described the implementation of a Geriatric Emergency Medicine Assessment (GEMA) team that assesses older adults in the emergency department (ED) and provides appropriate interventions. In a pre-post study, we found that GEMA assessment was associated with a 25- hour reduction in hospital LOS. Study ObjectivesUsing a case-control design on data collected from the first two years after implementation, we sought to quantify the reduction in hospital LOS and further elucidate the causes of this reduced time in the hospital. Using a case-control design on data collected from the first two years after implementation, we sought to quantify the reduction in hospital LOS and further elucidate the causes of this reduced time in the hospital. MethodsOur GEMA team consists of an advance practice provider who screens ED patients ≥65 years old for functional decline. If patients screen positive, additional assessments are performed, which can trigger interventions such as occupational therapy (OT) assessment in the ED. Here, we performed a nested case- control study from a larger cohort of patients consisting of all patients ≥65 years of age who presented to the ED between October 2019 and December 2021 and who were subsequently admitted to the hospital (n=34,412). Patients who were admitted to the intensive care unit or to the observation unit were excluded. Cases were designated as those patients who underwent GEMA assessment. Controls were patients who were not assessed by the GEMA team and were matched to cases in a 1:4 ratio, with replacement, based on the criteria age, sex, race, and Estimated Severity Index (ESI). Data was obtained by retrospective chart review. Our GEMA team consists of an advance practice provider who screens ED patients ≥65 years old for functional decline. If patients screen positive, additional assessments are performed, which can trigger interventions such as occupational therapy (OT) assessment in the ED. Here, we performed a nested case- control study from a larger cohort of patients consisting of all patients ≥65 years of age who presented to the ED between October 2019 and December 2021 and who were subsequently admitted to the hospital (n=34,412). Patients who were admitted to the intensive care unit or to the observation unit were excluded. Cases were designated as those patients who underwent GEMA assessment. Controls were patients who were not assessed by the GEMA team and were matched to cases in a 1:4 ratio, with replacement, based on the criteria age, sex, race, and Estimated Severity Index (ESI). Data was obtained by retrospective chart review. ResultsThere were 3,019 cases and 8,379 controls. The mean hospital LOS was 23 hours shorter for cases compared to controls (5.74 d vs 6.69 d; p<0.001). Cases were more likely to be discharged home after admission than to a subacute rehabilitation facility (SAR) (OR 1.22, 95% CI 1.08-1.33). For patients who were discharged home after admission, the mean difference in LOS was 11 h (4.64 d vs 5.10 d; p<0.001), and for patients who were discharged to a SAR after admission, the mean difference in LOS was 30 h (8.44 d vs 9.67 d; p=0.002). Patients who underwent OT assessment in the ED via the GEMA program and who were subsequently discharged to SAR after hospital admission had a reduction in LOS of 37 h (8.13 d vs 9.66 d; p=0.007). There were 3,019 cases and 8,379 controls. The mean hospital LOS was 23 hours shorter for cases compared to controls (5.74 d vs 6.69 d; p<0.001). Cases were more likely to be discharged home after admission than to a subacute rehabilitation facility (SAR) (OR 1.22, 95% CI 1.08-1.33). For patients who were discharged home after admission, the mean difference in LOS was 11 h (4.64 d vs 5.10 d; p<0.001), and for patients who were discharged to a SAR after admission, the mean difference in LOS was 30 h (8.44 d vs 9.67 d; p=0.002). Patients who underwent OT assessment in the ED via the GEMA program and who were subsequently discharged to SAR after hospital admission had a reduction in LOS of 37 h (8.13 d vs 9.66 d; p=0.007). ConclusionGEMA patients had a shorter hospital LOS than matched controls and were more likely to be discharged home. The greatest difference in hospital LOS was found in patients who were discharged to a SAR after hospital admission and for whom GEMA assessment had resulted in OT assessment in the ED. This implies that the difference in hospital length of stay is primarily driven by two factors: 1) an increased number of patients who are able to be discharged home; and 2) the early involvement of OT in patients discharged to SAR. Additional contributors to the decreased LOS, such as a reduction in the incidence of delirium, remain to be investigated.No, authors do not have interests to disclose GEMA patients had a shorter hospital LOS than matched controls and were more likely to be discharged home. The greatest difference in hospital LOS was found in patients who were discharged to a SAR after hospital admission and for whom GEMA assessment had resulted in OT assessment in the ED. This implies that the difference in hospital length of stay is primarily driven by two factors: 1) an increased number of patients who are able to be discharged home; and 2) the early involvement of OT in patients discharged to SAR. Additional contributors to the decreased LOS, such as a reduction in the incidence of delirium, remain to be investigated.