scholarly journals Emergency Department Observation Units and the Older Patient

2013 ◽  
Vol 29 (1) ◽  
pp. 71-89 ◽  
Author(s):  
Mark G. Moseley ◽  
Miles P. Hawley ◽  
Jeffrey M. Caterino
Keyword(s):  
Emergency Department ◽  
Older Patient ◽  
Observation Units

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units

2010 ◽  
Vol 17 (4) ◽  
pp. 197-202 ◽  
Author(s):  
Òscar Miró ◽  
Pere Llorens ◽  
Francisco Javier Martín-Sánchez ◽  
Pablo Herrero ◽  
Javier Jacob ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Heart Failure Patients ◽  
Observation Units

scholarly journals Protocol-Driven Emergency Department Observation Units Offer Savings, Shorter Stays, And Reduced Admissions

2013 ◽  
Vol 32 (12) ◽  
pp. 2149-2156 ◽  
Author(s):  
Michael A. Ross ◽  
Jason M. Hockenberry ◽  
Ryan Mutter ◽  
Marguerite Barrett ◽  
Matthew Wheatley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observation Units

The impact of a time target on older patients attending the emergency department

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A2.1-A2
Author(s):  
Sue Mason
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Age Groups ◽  
Unintended Consequences ◽  
Older Patient ◽  
Younger Patients ◽  
Patient Level ◽  
Level Data ◽  
Younger Age ◽  
The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

scholarly journals A National Dataset Analysis of older adults in emergency department observation units

2019 ◽  
Vol 37 (9) ◽  
pp. 1686-1690
Author(s):  
Lauren T. Southerland ◽  
Katherine M. Hunold ◽  
Christopher R. Carpenter ◽  
Jeffrey M. Caterino ◽  
Lorraine C. Mion
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Observation Units ◽  
Dataset Analysis

238: An Analysis of Emergency Department Observation Units Impact on Patient Satisfaction Scores

2009 ◽  
Vol 54 (3) ◽  
pp. S74-S75
Author(s):  
A. Chandra ◽  
D. Harrison ◽  
A. Boardwine ◽  
J. Villani ◽  
C. Gerardo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Observation Units ◽  
Patient Satisfaction Scores

Acute heart failure in the older patient in the emergency department

2014 ◽  
Vol 24 (4) ◽  
pp. 290-303 ◽  
Author(s):  
F. Javier Martín-Sánchez ◽  
Esther Rodríguez-Adrada ◽  
José Manuel Ribera Casado
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Heart Failure ◽  
Geriatric Syndrome ◽  
High Morbidity ◽  
Older Patient ◽  
Care Plans ◽  
Co Morbidity ◽  
Morbidity Risk ◽  
Hospital Emergency Departments

SummaryAcute heart failure is a highly prevalent geriatric syndrome presenting one of the most frequent reasons for visits to the emergency department and hospital admission, and is associated with a high morbidity and mortality and acute functional impact. The present study reviews some of the features that characterize diagnosis and immediate management of acute heart failure in older people, as well as recommendations about the management of co-morbidity, risk stratification and the decisión-making process, and the design of care plans in this older age group within the setting of hospital emergency departments.

scholarly journals Post-discharge Acute Care and Outcomes in the Era of Readmission Reduction

2019 ◽  
Author(s):  
Rohan Khera ◽  
Yongfei Wang ◽  
Susannah M. Bernheim ◽  
Zhenqiu Lin ◽  
Harlan M. Krumholz
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Care ◽  
Care Utilization ◽  
Post Discharge ◽  
Readmission Rates ◽  
Risk Of Death ◽  
Observation Units ◽  
Acute Care Utilization ◽  
Significant Change

ABSTRACTBackgroundWith incentives to reduce readmission rates, there are concerns that patients who need hospitalization after a recent hospital discharge may be denied access, which would increase their risk of mortality.ObjectiveWe determined whether patients with hospitalizations for conditions covered by national readmission programs who received care in emergency department (ED) or observation units but were not hospitalized within 30 days had an increased risk of death. We also evaluated temporal trends in post-discharge acute care utilization in inpatient units, emergency department (ED) and observation units for these patients.Design, Setting, and ParticipantsIn this observational study, national Medicare claims data for 2008-2016, we identified patients ≥65 years hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia, conditions included in the HRRP.Main Outcomes and MeasuresPost-discharge 30-day mortality according to patients’ 30-day acute care utilization. Acute care utilization in inpatient and observation units, and the ED during the 30-day and 31-90-day post-discharge period.ResultsThere were 3,772,924 hospitalizations for HF, 1,570,113 for AMI, and 3,131,162 for pneumonia. The overall post-discharge 30-day mortality was 8.7% for HF, 7.3% for AMI, and 8.4% for pneumonia. Post-discharge mortality increased annually by 0.16% (95% CI, 0.11%, 0.22%) for HF, decreased by 0.15% (95% CI, -0.18%, -0.12%) for AMI, and did not significantly change for pneumonia. Specifically, mortality only increased for HF patients who did not utilize any post-discharge acute care, increasing at a rate of 0.16% per year (95% CI, 0.11%, 0.22%), accounting for 99% of the increase in post-discharge mortality in heart failure. Concurrent with a reduction in 30-day readmission rates, 30-day observation stays and visits to the ED increased across all 3 conditions during and beyond the post-discharge 30-day period. There was no significant change in overall 30-day post-acute care utilization (P-trend >0.05 for all).Conclusions and RelevanceThe only condition with an increasing mortality through the study period was HF; the increase preceded the policy and was not present among those received ED or observation unit care without hospitalization. Overall, during this period, there was not a significant change in the overall 30-day post-discharge acute care utilization.

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