93 A Geriatric Assessment Program in the Emergency Department is Associated with Increased Discharge Rate and Decreased Hospital Length of Stay

Abstract

Patients over the age of 65 who present to the emergency department (ED) are more likely to be admitted to the hospital even without severe illness and, if admitted, have a longer length of stay in the hospital than younger patients. Our study objective was to determine if assessment and intervention by a trained ED Geriatric Intervention Team (GAT) would decrease the admission rate and reduce the hospital length of stay for admitted older adult patients. We conducted a case control study of the impact of a GAT in a large academic community ED, consisting of Advanced Practice Providers (APP), Care Management, and Occupational Therapy. From 8am through 6pm, Monday through Friday, the APP screened patients >= 65 years for functional decline and, if necessary, evaluated for cognitive delay, fall risk, delirium, and other geriatric risk factors and determined the need for intervention. Potential interventions include: OT assessment and intervention in the ED, rehabilitation placement, outpatient geriatric clinic referral and delirium management. We excluded patients triaged as critical. Data on patients who were assessed by the Geriatric APP were collected prospectively. Our control population (“unassessed” group) were geriatric ED patients admitted during the similar hours of operation 6 months prior to team intervention and geriatric ED patients admitted during the first 6 months of operation who were not assessed. We used the Charlson Comorbidity index (CCI) to characterize baseline health status. During the study period we screened 815 ED geriatric patients. Assessed and unassessed groups were demographically similar. We found that the “assessed” group was found to have a longer ED LOS than the “unassessed” group (mean time in hours: 4.94 vs 4.41, p<0.05), p<0.05), but hospital LOS was shorter by over 24 hours (mean time in days: 4.49 vs 5.52, p<0.05). The “assessed” group was more likely to be discharged (54% vs 30%, OR 0.55 (95% CI: 0.51, 0.59)). “Assessed” patients had fewer comorbidities than “unassessed” (mean CCI score: 2.23 vs 2.55, p<0.05). However, when analyzing only hospitalized patients, the “assessed” group and control group had similar CCI to the ”unassessed” group (mean CCI score: 2.57 vs 2.70, p=0.30). Patients who were assessed by the GAT were more likely to be discharged directly from the ED, and if admitted, hospital length of stay was reduced by over 24 hours. Assessed patients had fewer comorbidities, which may contribute to the increased percentage of discharges. However, admitted patients were similar in health status in both assessed and unassessed groups. A targeted intervention in the ED can reduce hospital length of stay in geriatric patients and may reduce admissions as well.