Evaluation of a care pathway for older adults presenting with nonspecific complaints at the emergency department: a before-and-after study.

PURPOSE

Managing older patients presenting at the Emergency Department (ED) poses challenges due to their predisposition to present with nonspecific complaints (NSC). With an ageing population and ED overcrowding, significance of NSC is expected to grow. Therefore, we implemented a structured care pathway to address the complexity of NSC presentations. The aim of this study is to evaluate the effectivity of this care pathway.

METHODS

We conducted a before-and-after study to evaluate the NSC care pathway, which included risk stratification, standardized assessment and diagnostic measurements. A control group receiving standard care was established in two hospitals (hospital 1 and 2) before implementation. Patient enrollment occurred from April 2021 to November 2024. Outcomes included length of stay in the ED (LOS-ED) and in hospital (LOS-H), revisits, diagnostic completeness (i.e. 100% agreement between all ED and hospital discharge diagnoses) and perceived quality of care.

RESULTS

In total, 164 control and 235 intervention patients were included in this study. Median LOS-ED and LOS-H did not show significant differences between the control and intervention patients. Implementation of the care pathway showed non-significant trends towards improved diagnostic completeness (47.1% vs 37.2%, p = 0.096). This might be associated with the non-significant observed decrease in 30-day readmissions (7.5% vs. 12.7%, p = 0.256). Patient-reported outcomes indicated a positive experience with the quality of care.

CONCLUSION

The care pathway did not improve LOS-ED and LOS-H as hypothesized, possibly due to logistical barriers and patient variability. However, trends suggested improved diagnostic completeness and fewer 30-day readmission rates. Further research initiatives are needed to enhance patient outcomes and care for NSC patients.

TRIAL REGISTRY NUMBER

NL8960, date 9-10-2020.