Prediction of Emergency Department Re-Visits in Older Patients by the Identification of Senior at Risk (ISAR) Screening

Abstract

The “Identification of Seniors at Risk” (ISAR) screening is a tool to identify seniors at risk of adverse outcomes. We investigated whether seniors with a positive ISAR screening have an increased risk of Emergency Department (ED) re-visits and health-service costs. In a pilot project, we enrolled 96 ED patients (≥70 years) who received an ISAR screening in the ED. We compared the rate of ED re-visits and in-hospital costs between ISAR positive (≥2 pts) and ISAR negative (<2 pts) patients. In some patients, a geriatrician performed a single Geriatric Consultation (GC) during the ED stay to assess older patients’ needs.32% of the study population had an unplanned ED re-visit (31 of 96). Fifty patients were ISAR positive (52%) and showed an increased risk of ED re-visits compared with ISAR negative patients (dds ratio (OR) 6.8, 95% confidence interval (CI) 2.2–21.0, p = 0.001). The positive ISAR screening tool fairly predicted ED re-visits in seniors (area under the curve (AUC) 0.711). A single GC during the ED stay did not reduce the risk of unplanned ED re-visits in ISAR positive patients (p = 0.80) ISAR positive patients with GC did not have higher in-hospital costs than ISAR negative patients without GC. Based on these findings, we aim to establish a comprehensive outpatient geriatric assessment program to identify relevant risk factors for ED re-visits and to recommend preventive strategies in ISAR positive ED seniors.