TY - JOUR
T1 - Geriatric Emergency Department Innovations
T2 - Transitional Care Nurses and Hospital Use
AU - The GEDI WISE Investigators
AU - Hwang, Ula
AU - Dresden, Scott M.
AU - Rosenberg, Mark S.
AU - Garrido, Melissa M.
AU - Loo, George
AU - Sze, Jeremy
AU - Gravenor, Stephanie
AU - Courtney, D. Mark
AU - Kang, Raymond
AU - Zhu, Carolyn W.
AU - Vargas-Torres, Carmen
AU - Grudzen, Corita R.
AU - Richardson, Lynne D.
N1 - Funding Information:
Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055– 01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor.
Funding Information:
Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255.
PY - 2018/3
Y1 - 2018/3
N2 - 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.
AB - 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.
KW - admission
KW - emergency department
KW - transitions of care
UR - http://www.scopus.com/inward/record.url?scp=85040337814&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040337814&partnerID=8YFLogxK
U2 - 10.1111/jgs.15235
DO - 10.1111/jgs.15235
M3 - Article
C2 - 29318583
AN - SCOPUS:85040337814
VL - 66
SP - 459
EP - 466
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 3
ER -