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 language | English (US) |
|---|---|
| Pages (from-to) | 459-466 |
| Number of pages | 8 |
| Journal | Journal of the American Geriatrics Society |
| Volume | 66 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2018 |
| Externally published | Yes |
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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 journal › Article
}
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 -