Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30‐day Readmissions for Older Adults

Abstract

ObjectivesTransitional care nurse (TCN) care has been associated with decreased hospitalizations for older adults in the emergency department (ED). The objective of this study was to evaluate the association between TCN care and readmission for geriatric patients who visit the ED within 30 days of a prior hospital discharge.MethodsWe studied a prospective cohort of ED patients aged 65 and older with an ED visit within 30 days of inpatient discharge. Patients with an Emergency Severity Index of 1 or prior TCN contact were excluded. Entropy balancing and logistic regression were used to estimate the average incremental effect of the TCN intervention on risk of admission during the index ED visit and within 30 days of prior discharge.ResultsOf 6,838 visits, 608 included TCN care. TCN patients had lower risk of readmission during the index ED visit at Mount Sinai Medical Center (MSMC), −10.1 percentage points (95% confidence interval [CI] = −18.5 to −2.7), and Northwestern Memorial Hospital (NMH), −17.3 percentage points (95% CI = −23.1 to −11.5), but not St. Joseph’s Regional Medical Center (SJRMC), −2.5 percentage points (95% CI = −10.5 to 5.5). TCN patients had fewer readmissions within 30 days of prior hospital discharge at NMH, −16.2 percentage points (95% CI = −22.0 to −10.3), but not at MSMC, −5.6 percentage points (95% CI = −13.1 to 1.8), or at SJRMC, 0.5 percentage points (95% CI = −7.2 to 8.2).ConclusionsTransitional care nurse care in the ED after a prior hospitalization was associated with decreased readmission of older adults during the index ED visit at two of three hospitals, with sustained reduction for the entire 30‐day readmission window at one hospital. TCN interventions in the ED may decrease readmissions for geriatric patients in the ED; however, these results may be dependent on implementation of the program and availability of ED, hospital, and local resources for older adults.

Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries

“…21 The cost savings found in this study were likely associated with a change in health care utilization and trajectory for the treated beneficiaries. In addition to GEDI WISE studies, 3,4,10 which have shown decreases in health services use, other studies [5][6][7][8][9][22][23][24]…”

“…2 Previous studies demonstrated that geriatrics-focused emergency care quality improvement efforts administered by transitional care nurses (TCNs) who were trained in geriatric-focused assessments to deliver care addressing needs of older adults were associated with reduced risk of hospital admission 3 and 30-day readmissions. 4 Other programs focused on interventions or initiatives targeting older ED patients immediately after ED discharge or early during their hospital admission have also been associated with reduced risk of subsequent readmission and decreased lengths of stay. [5][6][7][8][9] Although many hospitals and health care systems have incorporated GED initiatives targeting older ED patients as a part of their emergency care, most have not.…”

Geriatric Emergency Care Reduces Health Care Costs—What Are the Next Steps?

“…3 To date, the GEDI WISE investigators have demonstrated that this care model can decrease hospital admissions, future ED visits, and 30-day hospital readmissions. 4,5 Elsewhere in JAMA Network Open, Hwang et al 3 measured the cost savings associated with TCN or SW evaluations at GEDI WISE sites. Using entropy balancing, they compared the total Medicare costs for 30 and 60 days after the index ED visit among an intervention group of fee-for-service Medicare beneficiaries who received a TCN or SW evaluation and a control group of fee-for-service Medicare beneficiaries who did not.…”

“… 3 To date, the GEDI WISE investigators have demonstrated that this care model can decrease hospital admissions, future ED visits, and 30-day hospital readmissions. 4 , 5 …”

Geriatric Emergency Medicine Fellowships: Current State of Specialized Training for Emergency Physicians in Optimizing Care for Older Adults

“…They are also more likely than younger adults to have adverse outcomes after ED discharge . High‐quality ED care has the potential to make a dramatic impact on an older adult’s health, both in managing their acute complaint and in potentially identifying and intervening to address functional decline.…”