235: Prolonged Stay in the Emergency Department is Detrimental to Older Adults

Article Outline

• Study Objectives
• Methods
• Results
• Conclusion
• Copyright

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Study Objectives 

Decline in functional status in older adults is known to follow emergency department (ED) visit and/or hospitalization. This decline may lead to loss of independent living, requiring placement in higher levels of care such as assisted living facilities or nursing homes (NH). Older adults with extended ED stays may be at even higher risk. We performed a pilot study to determine if older adult inpatients were less likely to be discharged home if they spent more than 6 hours in the ED. This timeframe was chosen because Australia and Great Britain limit ED stays to 6 hours.

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Methods 

Patients 65 years of age or older presenting to the ED of a large urban teaching hospital between Aug1-Aug 31, 2007 were included. Nursing home and assisted living facility residents were also excluded. Patients admitted to the psychiatric ED, ICU, or observation unit were excluded, as were patients admitted for a hip fracture (all admitted to NH for rehabilitation) or discharged to hospice. Final disposition, ED and hospital length of stay, referral to home care nursing, and readmission within 30 days were recorded. Appropriate length of stay was defined as less than 6 hours while extended stay was defined as greater than or equal to 6 hours. Fisher’s exact test was used to compare results.

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Results 

8095 patients were seen during the 1 month period. 908 (11%) were 65 years or older. 52% were male; 38% were admitted to the inpatient service, 5% to the ICU, 20% to a 23 hour observation unit; 37% were treated and released. 7 patients were seen in the psychiatric ED. Of the 341 inpatients, 53 were eliminated based on pre-established exclusion criteria; 11 additional patients were eliminated because of missing data, leaving 277 patients (median age 76) for analysis. Of the 277 inpatients, 30 were in the ED less than 6 hours (appropriate stay) and one died while in the hospital. 247 had extended stays, and 5 died in the hospital. Appropriate stay patients were discharged home significantly more frequently than extended stay patients (96% vs. 82%, p=0.05). Median inpatient length of stay was shorter for appropriate stay patients (4.5 vs. 6). No difference was seen in the use of home care nursing or readmission to the hospital. This pilot study was performed at a single site over a limited time frame. We did not measure all potential confounding variables. We cannot determine a cause for these findings.

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Conclusion 

Older adult patients who have extended stays in the ED are less likely to be discharged home. Future studies should focus on the cause of the phenomena, including the development of delirium.