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Enhancing Emergency Medical Care for Seniors Could Reduce Hospital Admissions

Early palliative care cuts hospital lengths of stay and costs

Applying principles of palliative care to emergency departments (EDs) may reduce the number of geriatric patients admitted to intensive care units, possibly extending lives and reducing Medicare costs, according to a 3-year analysis by Mount Sinai researchers set to be published in the May edition of Health Affairs.

“Data show that more than half of Americans ages 65 and older are seen in the emergency department in the last month of their lives, and that the number and rate of admissions to intensive care units among older adults who are seen in the ED have also increased,” said lead author Corita Grudzen, MD. “Our findings suggest that early palliative-care inpatient consultation can improve care for older patients, decrease hospital lengths of stay and costs, and even extend life. The potential for this approach to improve the quality and value of geriatric emergency care warrants continued study.”

The changes in emergency care examined in this preliminary analysis were developed through Mount Sinai’s Geriatric Emergency Department Innovations in Care Through Workforce, Informatics, and Structural Enhancements (GEDI WISE) program.

Under the GEDI WISE model, changes in ED staff training and practice (workforce enhancements) were introduced at the Mount Sinai Hospital, including role redefinition and education in palliative-care principles. As part of the training:

  • ED triage nurses learned to screen patients aged 65 years and older to identify those at high risk of an ED revisit and hospital readmission.
  • ED nurse practitioners learned to identify high-risk patients suitable for and desiring palliative and hospice care, and how to expedite referrals.

The screening of ED patients with the Identification of Seniors at Risk (ISR) tool was instituted in October 2012. Researchers found that 59% of the 8,519 visitors to Mount Sinai’s ED aged 65 years and older who were screened with the tool had a score that indicated an increased risk for revisit and readmission. The five most common presenting diagnoses among this cohort were chest pain, shortness of breath, malaise and fatigue, abdominal pain, and dizziness.

Specifically, the analysis by Grudzen and her colleagues found that using the GEDI WISE model brought about a 1.4% decrease in the rate of intensive care unit (ICU) admissions from the ED in patients aged 65 years and older at the Mount Sinai Hospital. This decrease remained significant even after changes in comorbidity and other key characteristics of ED patients in this age group were accounted for.

The absolute reduction of 1.4% in ICU admissions from the ED during the study period, in which there were 38,240 unique ED encounters, corresponded to a decrease of 535 ICU admissions. Assuming that these patients were admitted to the hospital, this drop in admissions would produce an estimated savings to Medicare of more than $3.14 million.

Source: EurekAlert; May 4, 2015.

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