Admission of Older Patients to Geriatric Inpatient Care from the Emergency Department Compared with Admission through Acute Medical Unit: Cost and Length of Stay Outcomes.

OBJECTIVE

To investigate whether direct admission to geriatric inpatient care from the emergency department (EMD) was associated with lower length of stay (LOS) and cost compared to patients admitted through an acute medical unit (AMU).

METHODS

Retrospective single-centre cohort study conducted using hospital database on older patients ≥ 75 years discharged from geriatric inpatient service in a tertiary academic centre from March 2021 to September 2021 who were admitted through AMU or direct from EMD.

INTERVENTION

Traditional AMU run by internists followed by geriatrician led-care compared with geriatrician led-care.

MEASURE

We evaluated the difference in median length of stay (LOS), and cost using quantile regression adjusted for primary discharge diagnoses, hospital frailty risk score (HFRS) and Age-adjusted Charlson Comorbidity Index (ACCI).

RESULTS

Among 574 older patients, 140 (24.4%) were admitted from AMU. Mean age was 84.0 ± 6.3 years and 83.8% were categorized as high or intermediate frailty risk based on HFRS. 46% of patients admitted through EMD were discharged within three days. After adjusting for primary diagnoses, HFRS, and ACCI, patients admitted through AMU had a longer median LOS of 1.6 days (95% confidence interval (CI): 0.86-2.4, p<0.001), higher total cost $1386.0 (95% CI 733-2038, p<0.001), laboratory cost $226.0 (95% CI 131-322, p<0.001), medication cost $65.0 (95% CI 15-115, p<0.010), physiotherapy cost $45.0 (95% CI 16-75, p=0.002) and occupational therapy cost $35.0 (95% CI 12-58, p=0.003).

CONCLUSION

Older adults admitted through AMU had significantly longer median LOS, higher total cost, physiotherapy and occupational therapy costs, medication, and laboratory costs.