298 Falls and Syncope in Older People in the Emergency Department: Prevalence, Clinical Characteristics and Outcomes

Abstract Background Falls, syncope and presyncope comprise a large proportion of emergency department (ED) presentations among older people, however accurate data detailing this is limited. The aim of this study therefore was to ascertain the percentage of ED presentations in older people due to falls/syncope/presyncope, and examine admission rates, length of stay and likely underlying diagnosis. Methods Over 1,300 consecutive presentations of older people (aged ≥60 years) to the ED of a large urban university teaching hospital in March 2018 were examined (electronic and hard-copy notes) to ascertain the prevalence of falls/syncope/presyncope presentations. Data was collected for each presentation with fall/syncope/presyncope on demographics, and relevant clinical characteristics, including admission outcome and length of stay (LOS). Results Falls/syncope/presyncope comprised 19% (250/1,324) of presentations of older people to the ED, with a mean age of 75.3 +/-0.64 years. Almost 60% (158/250) presented during ‘normal’ working hours, i.e. Monday to Friday, 0800-1800. Almost half (121/250) had a Manchester Triage Score (MTS) of 3, indicating a need for urgent care, while one third (93/250) were categorized as requiring very urgent or immediate assessment (MTS 2 or 1 respectively). Over one third (97/250) presented with explained/accidental falls, while 26% (66/250) and 35% (87/250) presented with syncope and unexplained falls respectively. One in two (118/250) older people presenting with falls/syncope/presyncope were admitted to the acute hospital, and this rises to almost two thirds (82/135) of those aged ≥75 years. The median LOS was 15 (9.9 -22.0) days. Conclusion Older people frequently present to the ED with falls/syncope/presyncope. The majority present during working hours and admission rates and LOS are relatively high. Falls/syncope/presyncope therefore represent an appropriate target for structured, multidisciplinary assessment at the ‘front door’ to provide early specialist assessment and management, and reduce complications associated with unnecessary admission to hospital.

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Influences on emergency department length of stay for older people

European Journal of Emergency Medicine ◽

10.1097/mej.0000000000000452 ◽

2018 ◽

Vol 25 (4) ◽

pp. 242-249 ◽

Cited By ~ 8

Author(s):

Maryann Street ◽

Mohammadreza Mohebbi ◽

Debra Berry ◽

Anthony Cross ◽

Julie Considine

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Older People

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Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽

10.1093/qjmed/hcaa261 ◽

2020 ◽

Author(s):

K Jusmanova ◽

C Rice ◽

R Bourke ◽

A Lavan ◽

C G McMahon ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Admission Rate ◽

Readmission Rates ◽

Specialist Service ◽

Admission Rates ◽

Potential Benefits ◽

Bed Days ◽

The Mean ◽

The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

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Emergency department admissions, older people, functional decline, and length of stay in hospital

Australasian Journal on Ageing ◽

10.1111/j.1741-6612.2004.00048.x ◽

2004 ◽

Vol 23 (4) ◽

pp. 189-194 ◽

Cited By ~ 9

Author(s):

David A Conforti ◽

David Basic ◽

Jeffrey T Rowland

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Older People ◽

Functional Decline

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The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study

BMC Geriatrics ◽

10.1186/1471-2318-12-8 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 32

Author(s):

Glenn Arendts ◽

Sarah Fitzhardinge ◽

Karren Pronk ◽

Mark Donaldson ◽

Marani Hutton ◽

...

Keyword(s):

Emergency Department ◽

Clinical Study ◽

Older People ◽

Allied Health ◽

Health Intervention ◽

Admission Rates ◽

Randomized Clinical Study ◽

The Impact

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First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

10.1101/2021.12.09.21267520 ◽

2021 ◽

Author(s):

Robi Dijk ◽

Patricia Plaum ◽

Stan Tummers ◽

Frits van Osch ◽

Dennis Barten ◽

...

Keyword(s):

Emergency Department ◽

Urgent Care ◽

Emergency Department Utilization ◽

Reference Period ◽

Wave Dynamics ◽

Admission Rates ◽

High Urgency ◽

Ed Visits ◽

Second Wave ◽

Insight Into

Background: Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. Methods: We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March until June and September until December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non)COVID suspected. Findings: During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non COVID visits. Interpretation: During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

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Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116164 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6164

Author(s):

Cheng-Fu Lin ◽

Po-Chen Lin ◽

Sung-Yuan Hu ◽

Yu-Tse Tsan ◽

Wei-Kai Liao ◽

...

Keyword(s):

Emergency Department ◽

Older People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Multivariate Regression ◽

Multivariate Regression Analysis ◽

Intervention Period ◽

Frailty Phenotype ◽

Admission Rates

Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before–after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ≥75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.

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152 Implementation of Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)

Age and Ageing ◽

10.1093/ageing/afz103.89 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Comfort Adedokun ◽

Rosa McNamara ◽

Nessa O’Herlihy

Keyword(s):

Older Adults ◽

Emergency Department ◽

Older People ◽

Rapid Assessment ◽

Admission Rate ◽

Clinical Decision ◽

Admission Rates ◽

Clinical Decision Unit ◽

Medical Referral ◽

The Impact

Abstract Background The Emergency Department (ED) is where most people, including older adults in crises, seek care. OPRAH was introduced in order to meet the needs of our changing population. The unit was developed out of existing resources within the ED and cohorts both older patients and staff to an area more suitable to carry out assessments. Methods We used a quality improvement framework to develop our service. OPRAH is led by an ED GEM (Geriatric Emergency Medicine) consultant, staffed using the existing ED team, housed within footprint of the ED as part of the Clinical Decision Unit (CDU) with the addition of an HCA (healthcare assistant) as required. To determine the impact of the service on admissions of older adults, we collated patient records prospectively. These were reviewed and coded by senior ED professionals blinded to outcomes, to determine medical-referral rate for admission in these cohort. Results In the first 3 weeks of implementation, 76 patients were assessed. Four were admitted and 2 transferred to other hospitals. Mean age was 83 years ranging 66-103 years with an average of 262 minutes in the ED prior to OPRAH admission. Blinded coders review determined 53 (76%) of these patients would have been referred for admission. The majority of the remainder would have completed their care in the ED, as they were not eligible for admission to CDU. Conclusion Introduction of OPRAH to the ED has improved access for older people to short-stay ED led care and reduced admission rates. We have identified a trend towards fewer episodes where care by in-house teams is completed within the ED. We are in an early phase of this project. Nonetheless, it is evident that by redesigning how we assess older people in the ED and using available outpatient resources, we could impact on admission rate and length of stay in the ED without compromising patient care. Implementation has increased the use of the integrated care team, hospital and community MDT (multidisciplinary team).

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