Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

The GEDI WISE Investigators

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)459-466
Number of pages8
JournalJournal of the American Geriatrics Society
Volume66
Issue number3
DOIs
StatePublished - Mar 2018
Externally publishedYes

Fingerprint

Geriatrics
Hospital Emergency Service
Nurses
Confidence Intervals
Inpatients
Patient Transfer
Transitional Care
Selection Bias
Entropy

Keywords

  • admission
  • emergency department
  • transitions of care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Geriatric Emergency Department Innovations : Transitional Care Nurses and Hospital Use. / The GEDI WISE Investigators.

In: Journal of the American Geriatrics Society, Vol. 66, No. 3, 03.2018, p. 459-466.

Research output: Contribution to journalArticle

@article{597168c0172d4ab99e8b8d40ed86574b,
title = "Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use",
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.",
keywords = "admission, emergency department, transitions of care",
author = "{The GEDI WISE Investigators} and Ula Hwang and Dresden, {Scott M.} and Rosenberg, {Mark S.} and Garrido, {Melissa M.} and George Loo and Jeremy Sze and Stephanie Gravenor and Courtney, {D. Mark} and Raymond Kang and Zhu, {Carolyn W.} and Carmen Vargas-Torres and Grudzen, {Corita R.} and Richardson, {Lynne D.}",
year = "2018",
month = "3",
doi = "10.1111/jgs.15235",
language = "English (US)",
volume = "66",
pages = "459--466",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "3",

}

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.

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 -