An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments - 20/11/23
, Ula Hwang, MD, MPH a, c, Alexander T. Janke, MD, MHS a, d, Craig Rothenberg, MPH a, Debra F. Tomasino, MA a, Sandra M. Schneider, MD e, Pawan Goyal, MD, MHA e, Arjun K. Venkatesh, MD, MBA a, bAbstract |
Study objective |
We sought to describe diagnosis rates and compare common process outcomes between geriatric emergency departments (EDs) and nongeriatric EDs participating in the American College of Emergency Physicians Clinical Emergency Data Registry (CEDR).
Methods |
We conducted an observational study of ED visits in calendar year 2021 within the CEDR by older adults. The analytic sample included 6,444,110 visits at 38 geriatric EDs and 152 matched nongeriatric EDs, with the geriatric ED status determined based on linkage to the American College of Emergency Physicians’ Geriatric ED Accreditation program. Stratified by age, we assessed diagnosis rates (X/1000) for 4 common geriatric syndrome conditions and a set of common process outcomes including the ED length of stay, discharge rates, and 72-hour revisit rates.
Results |
Across all age categories, geriatric EDs had higher diagnosis rates than nongeriatric EDs for 3 of the 4 following geriatric syndrome conditions of interest: urinary tract infection, dementia, and delirium/altered mental status. The median ED site-level length of stay for older adults was lower at geriatric EDs compared with that at nongeriatric EDs, whereas 72-hour revisit rates were similar across all age categories. Geriatric EDs exhibited a median discharge rate of 67.5% for adults aged 65 to 74 years, 60.8% for adults aged 75 to 84 years, and 55.6% for adults aged >85 years. Comparatively, the median discharge rate at nongeriatric ED sites was 69.0% for adults aged 65 to 74 years, 64.2% for adults aged 75 to 84 years, and 61.3% for adults aged >85 years.
Conclusion |
Geriatric EDs had higher geriatric syndrome diagnosis rates, lower ED lengths of stay, and similar discharge and 72-hour revisit rates when compared with nongeriatric EDs in the CEDR. These findings provide the first benchmarks for emergency care process outcomes in geriatric EDs compared with nongeriatric EDs.
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| Please see page 682 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Timothy F. Platts-Mills, MD, MSc. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: CJG, UH, and AKV conceived the study design. ATJ and CR performed analyses. All authors iteratively drafted the article, contributed substantially to its revision, and approved the final article. CJG takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Dr. Gettel is a Pepper Scholar with support from the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342) and the National Institute on Aging (NIA) of the National Institutes of Health (NIH; R03AG073988). Dr. Hwang is supported by the NIA (R33AG058926 and R61A069822), the John A Hartford Foundation, West Health Institute, and the Dolby Family Foundation. Dr. Janke reports being supported by the Veterans Affairs (VA) Office of Academic Affiliation through the VA/National Clinician Scholars Program and the University of Michigan. Dr. Venkatesh reports support by the American Board of Emergency Medicine National Academy of Medicine Anniversary fellowship during this work and prior support from the Yale Center for Clinical Investigation grant KL2 TR000140 from the National Center for Advancing Translational Sciences (NCATS/NIH). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript. |
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| Presentation information: This work was presented at the 2023 American Geriatric Society annual meeting in Long Beach, CA, and the 2023 Society for Academic Emergency Medicine annual meeting in Austin, TX. |
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| Disclaimer: Dr. Gettel is a reviewer for the Geriatric Emergency Department Accreditation (GEDA) process. Drs. Gettel and Venkatesh serve on the American College of Emergency Physicians (ACEP) Clinical Emergency Data Registry Committee and Drs. Gettel, Hwang, and Venkatesh serve on the ACEP Quality and Patient Safety Committee. Dr. Schenider is the Senior Vice President of Clinical Affairs at ACEP, and Dr. Goyal is the Senior Vice President of Quality at ACEP. |
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Vol 82 - N° 6
P. 681-689 - décembre 2023 Retour au numéro
Article précédent
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