Abstract
BackgroundSeniors comprise 14% to 21% of all emergency department (ED) visits, yet are disproportionately larger users of ED and inpatient resources. ED care coordinators (EDCCs) target seniors at risk for functional decline and connect them to home care and other community services in hopes of avoiding hospitalization.The goal of this study was to measure the association between the presence of EDCCs and admission rates for seniors aged ≥ 65. Secondary outcomes included length of stay, recidivism at 30 days, and revisit resulting in admission at 30 days.MethodsThis was a matched pairs study using administrative data from eight EDs in six Alberta cities. Four of these hospitals were intervention sites, in which patients were seen by an EDCC, while the other four sites had no EDCC presence. All seniors aged ≥ 65 with a discharge diagnosis of fall or musculoskeletal pathology were included. Cases were matched by CTAS category, age, gender, mode of arrival, and home living environment. McNemar’s test for matched pairs was used to compare admission and recidivism rates at EDCC and non-EDCC hospitals. A paired t-test was used to compare length of stay between groups.ResultsThere were no statistically significant differences for baseline admission rate, revisit rate at 30 days, and readmission rate at 30 days between EDCC and non-EDCC patients.ConclusionsThis study showed no reduction in senior patients’ admission rates, recidivism at 30 days, or hospital length of stay when comparing seniors seen by an EDCC with those not seen by an EDCC.
Highlights
Seniors comprise 14% to 21% of all emergency department (ED) visits, yet are disproportionately larger users of ED and inpatient resources
Of the 1,820 patients included in the study (EDDC and non-Emergency Department Care Coordinator (EDCC)), 547 (30.1%) were admitted to hospital at the baseline and 354 (19.5%) revisited emergency during the 30-day follow-up period; 140 patients (7.7%) were admitted to hospital within the follow-up period
This study found no statistically significant differences in the hospital admission rates, length of stay (LOS) or ED re-visits within 30 days of an initial visit for seniors seen by an EDCC and those not seen by an EDCC
Summary
Older adults use emergency services at a higher rate, are more likely to be admitted or have repeat emergency department (ED) visits, and experience higher rates of adverse health outcomes after discharge [1]. In addition to their increased patterns of ED use, frail elderly patients seek care for falls, a presenting complaint not often seen in the young [1]. E2H connects seniors visiting the ED with services in the community through the efforts of the Emergency Department Care Coordinator (EDCC). EDCCs educate and advocate for patients and their families by identifying seniors needs outside the ED through conducting an assessment and providing referrals to home care and other community-based services
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