Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Authors

Ula Hwang
Scott M. Dresden
Mark S. Rosenberg, New York Medical CollegeFollow
Melissa M. Garrido
George Loo
Jeremy Sze
Stephanie Gravenor
Lynne D. Richardson
GEDI WISE Investigators

DOI

10.1111/jgs.15235

Journal Title

Journal of the American Geriatrics Society

First Page

459

Last Page

466

Document Type

Article

Publication Date

3-1-2018

Department

Emergency Medicine

Abstract

OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period. MEASUREMENTS: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0-30) and 72-hour ED revisits. RESULTS: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: -9.9% risk of inpatient admission, 95% confidence interval (CI) = -12.3% to -7.5%; site 2: -16.5%, 95% CI = -18.7% to -14.2%; site 3: -4.7%, 95% CI = -7.5% to -2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7-2.3%; site 2: 1.4%, 95% CI = 0.7-2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: -7.8%, 95% CI = -10.3% to -5.3%; site 2: -13.8%, 95% CI = -16.1% to -11.6%). CONCLUSION: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

Comments

Please see the work itself for the complete list of authors.

Recommended Citation

Hwang, U., Dresden, S., Rosenberg, M., Garrido, M., Loo, G., Sze, J., Gravenor, S., Richardson, L., & GEDI WISE Investigators. (2018). Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use. Journal of the American Geriatrics Society, 66 (3), 459-466. https://doi.org/10.1111/jgs.15235

Publisher's Statement

This is the author's accepted manuscript. The final edited version of this article is available at https://doi.org/10.1111/jgs.15235