Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department

Gelder, Jelle de; Lucke, Jacinta A.; Groot, Bas de; Fogteloo, A.J.; Anten, Sander; Heringhaus, Christian; Dekkers, Olaf M.; Blauw, Gerard J.; Mooijaart, Simon P.

doi:10.1111/jgs.15301

Cited by 62 publications

(72 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is similar to the results of Suffoletto et al [ 12 ] who concluded that concordances between patients, their caregivers and emergency physicians on the preventability of the ED visit within 30 days of hospital discharge were poor and there were significant discordances in identifying an intervention in order to potentially prevent the ED visit. In line with de Gelder et al [ 24 ], our results show that patients returning to the ED are in a high need of care. This could be a sign that there is more going on than their medical health issues alone.…”

Section: Discussionsupporting

confidence: 92%

Unplanned return presentations of older patients to the emergency department: a root cause analysis

et al. 2020

View full text Add to dashboard Cite

Background In line with demographic changes, there is an increase in ED presentations and unplanned return presentations by older patients (≥70 years). It is important to know why these patients return to the ED shortly after their initial presentation. Therefore, the aim of this study was to provide insight into the root causes and potential preventability of unplanned return presentations (URP) to the ED within 30 days for older patients. Methods A prospective observational study was conducted from February 2018 to November 2018 in an academic hospital in Amsterdam. We included 83 patients, aged 70 years and older, with an URP to the ED within 30 days of the initial ED presentation. Patients, GPs and doctors at the ED were interviewed by trained interviewers and basic administrative data were collected in order to conduct a root cause analysis using the PRISMA-method. Results One hundred fifty-one root causes were identified and almost half (49%) of them were disease-related. Fifty-two percent of the patients returned to the ED within 7 days after the initial presentation. In 77% of the patients the URP was related to the initial presentation. Patients judged 17% of the URPs as potentially preventable, while doctors at the ED judged 25% and GPs 23% of the URPs as potentially preventable. In none of the cases, there was an overall agreement from all three perspectives on the judgement that an URP was potentially preventable. Conclusion Disease-related factors were most often identified for an URP and half of the patients returned to the ED within 7 days. The majority of the URPs was judged as not preventable. However, an URP should trigger healthcare workers to focus on the patient’s process of care and their needs and to anticipate on potential progression of disease. Future research should assess whether this may prevent that patients have to return to the ED.

show abstract

Section: Discussionsupporting

confidence: 92%

Unplanned return presentations of older patients to the emergency department: a root cause analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…As frequent users of the healthcare system, PwD and their caregivers rely extensively on emergency department (ED) services to address acute medical needs and challenging behavioral symptoms, more so than other older adults . ED use by PwD has been associated with higher rates of poor outcomes, including greater 30‐day ED return rates; increased delirium, falls, behavioral problems, and mortality rates; and decreases in physical function . Although the cause of these poor outcomes remains unknown, the overstimulating and unfamiliar environments, limited information available to providers, and lack of provider‐patient relationships are seen as contributing factors …”

mentioning

confidence: 99%

“…1,5,6 ED use by PwD has been associated with higher rates of poor outcomes, including greater 30-day ED return rates; increased delirium, falls, behavioral problems, and mortality rates; and decreases in physical function. [6][7][8][9] Although the cause of these poor outcomes remains unknown, the overstimulating and unfamiliar environments, limited information available to providers, and lack of provider-patient relationships are seen as contributing factors. 8,10 Because the majority of PwD presenting to the ED do not require hospitalization, researchers are working to develop alternative ways of providing services that better address PwD needs.…”

mentioning

confidence: 99%

Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs

Jacobsohn

Hollander

Beck

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVES People with dementia (PwD) frequently use emergency care services. To mitigate the disproportionately high rate of emergency care use by PwD, an understanding of contributing factors driving reliance on emergency care services and identification of feasible alternatives are needed. This study aimed to identify clinician, caregiver, and service providers' views and experiences of unmet needs leading to emergency care use among community‐dwelling PwD and alternative ways of addressing these needs. DESIGN Qualitative, employing semistructured interviews with clinicians, informal caregivers, and aging service providers. SETTING Wisconsin, United States. PARTICIPANTS Informal caregivers of PwD (n = 4), emergency medicine physicians (n = 4), primary care physicians (n = 5), geriatric healthcare providers (n = 5), aging service providers (n = 6), and community paramedics (n = 3). MEASUREMENTS Demographic characteristics of participants and data from semistructured interviews. FINDINGS Four major themes were identified from interviews: (1) system fragmentation influences emergency care use by PwD, (2) informational, decision‐making, and social support needs influence emergency care use by PwD, (3) emergency departments (EDs) are not designed to optimally address PwD and caregiver needs, and (4) options to prevent and address emergency care needs of PwD. CONCLUSION Participants identified numerous system and individual‐level unmet needs and offered many recommendations to prevent or improve ED use by PwD. These novel findings, aggregating the perspectives of multiple dementia‐care stakeholder groups, serve as the first step to developing interventions that prevent the need for emergency care or deliver tailored emergency care services to this vulnerable population through new approaches. J Am Geriatr Soc 67:711–718, 2019.

show abstract

“…For example, unrecognized dementia is associated with diagnostic inaccuracy as clinicians evaluate a patient's acute complaints and the cause of their symptoms . Dementia is also associated with increased use of the ED, prolonged ED length of stay, increased admission rates, prolonged hospitalizations, incident delirium, fall risk, and higher mortality, as well as subsequent ED returns and hospital readmissions . Therefore, older adults with dementia represent a vulnerable ED population that will present with increasing frequency over coming decades.…”

mentioning

confidence: 99%

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter

Banerjee

Keyes

et al. 2018

Academic Emergency Medicine

View full text Add to dashboard Cite

ED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.

show abstract

Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department

Abstract: Age, male sex, polypharmacy, and cognitive impairment were independent predictors of a 30-day ED revisit, but no useful clinical prediction model could be developed. However, an early ED revisit is a strong new predictor of adverse outcomes in older adults.

Cited by 62 publications

References 37 publications

Unplanned return presentations of older patients to the emergency department: a root cause analysis

Unplanned return presentations of older patients to the emergency department: a root cause analysis

Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Contact Info

Product

Resources

About