The effect of direct admission to acute geriatric units compared to admission after an emergency department visit on length of stay, postacute care transfers and ED return visits

Abstract

Abstract Background Compared with conventional hospitalization, admission to an acute geriatric care unit (AGU) is associated with better outcomes in elderly patients. In 2012, 50% of the hospitalizations of elderly patients were preceded by an emergency department (ED) visit. Hospital occupancy, access blocks and overcrowding experienced by patients during ED visits are associated with increased morbidity. Objective Our aim was to evaluate the effect of direct admission (DA) to an AGU on both the hospital length of stay and morbidity of elderly patients. Design This study was a retrospective cohort study conducted using electronic medical records and administrative claims data from the Greater Paris University Hospitals (APHP) health data warehouse involving 19 different AGUs. Participants We included all patients ≥ 75 years old who were admitted to an AGU for more than 24 h between January 1, 2013, and December 31, 2018. Intervention Direct admission to the AGU compared to admission after an ED visit. Main measures The main outcome was hospital length of stay. Two outcomes were used to analyse morbidity: postacute care and rehabilitation ward transfer at the end of the index hospitalization and ED return visit within 30 days after the index hospitalization (for those who survived to hospitalization). We used an inverse probability of treatment weighting (IPTW) approach to balance the differences in patient baseline variables between the two groups. Univariate linear and logistic regression models were built to estimate the effect of DA on hospital length of stay and the likelihood of postacute care transfer and ED return visit. Key results Among the 6583 patients included in the study, DA was associated with a lower hospital length of stay (estimate = -1.28; 95% CI = -1.76–0.80), and a lower likelihood of postacute care transfer (OR = 0.87; 95% CI = 0.77–0.97). It was not significantly associated with a lower risk of ED return visits (OR = 0.81; 95% CI = 0.60–1.08) in the following month. Conclusion DA should be prioritized, and reorganization of the geriatric pathway around DA should be encouraged due to the frailty of elderly individuals.

Keywords

• Elderly
• Emergency department
• Emergency medicine
• Geriatrics
• Health Service Research