Advocate Aurora Health, Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA.
Department of Senior Services, Advocate Aurora Health, Milwaukee, Wisconsin, USA.
J Am Geriatr Soc. 2023 Mar;71(3):821-831. doi: 10.1111/jgs.18137. Epub 2022 Dec 1.
Compared with younger adults who receive care in the emergency department (ED), older patients who are discharged home have greater risk of adverse health outcomes. Connecting older adults with outpatient care following ED discharge are among the guidelines of the Geriatric Emergency Department (GED). The objective of this study was to examine the association between referral order placed during the ED visit for older adults and post-discharge follow-up to the outcomes of 72-h ED revisit, 30-day ED revisit, and 30-day all cause and unplanned hospital admission.
We conducted a retrospective cohort study. Ten accredited GEDs within one midwestern health system and all ED encounters of older adults aged 65 years and older who were discharged home from the ED between July 2019 and December 2020 were included. Predictor variables included age, sex, race, ISAR©, ED Length of Stay, post-ED referral order, and follow-up.
Among the older adults discharged home from the ED, 17% of older adult encounters had an outpatient referral ordered in the ED, 48.4% attended a follow-up appointment. Referrals were ordered for 69 referral order types with orthopedic, family practice, and urology referrals as the top 3. In mixed-effect regression models, compared with older adults with follow-up, those with a referral order but no follow-up had 19% higher odds of having a 30-day ED revisit (OR = 1.19; 95% CI = 1.07-1.31) and 11% higher odds of having 30-day unplanned hospital admission (OR = 1.11; 95% CI = 0.98-1.26).
Older adults who had an outpatient referral ordered prior to ED discharge and followed up had lower odds of a 30-day ED revisit and 30-day subsequent unplanned hospital admission. However, less than half of patients with a referral order attended a follow-up appointment. Designing interventions for older adults aimed at improving follow-up after an ED visit is needed.
与在急诊科（ED）接受治疗的年轻成年人相比，出院回家的老年患者有更大的不良健康结局风险。将老年人与 ED 出院后的门诊护理联系起来是老年急诊科（GED）指南的一部分。本研究的目的是检查 ED 就诊期间为老年人开具的转介医嘱与 72 小时 ED 复诊、30 天 ED 复诊以及 30 天全因和非计划住院治疗结局之间的关联。
我们进行了一项回顾性队列研究。一家中西部医疗系统内的 10 个认证 GED 和 2019 年 7 月至 2020 年 12 月期间从 ED 出院回家的 65 岁及以上老年人的所有 ED 就诊均包括在内。预测变量包括年龄、性别、种族、ISAR©、ED 住院时间、ED 后转介医嘱和随访。
在从 ED 出院回家的老年人中，17%的老年人在 ED 就诊时开具了门诊转介医嘱，48.4%的老年人接受了随访。共开具了 69 种转介医嘱类型，骨科、家庭医学和泌尿科转介位列前 3 位。在混合效应回归模型中，与有随访的老年人相比，有转介医嘱但无随访的老年人 30 天 ED 复诊的可能性高 19%（OR=1.19；95%CI=1.07-1.31），30 天非计划住院的可能性高 11%（OR=1.11；95%CI=0.98-1.26）。
在 ED 出院前开具了门诊转介医嘱并进行了随访的老年人，30 天 ED 复诊和 30 天后续非计划住院的可能性较低。然而，只有不到一半的有转介医嘱的患者接受了随访。需要为 ED 就诊后的老年人设计干预措施，以提高随访率。
