Frequent ED attendance by older adults was associated with higher in-hospital mortality (7.0% vs 3.2%, P<0.001) and hospital admission (69.2% vs 67.2%, P=0.004) than non-frequent attendance.
Cohort (n=21,073)
Yes
Do older frequent ED attenders have worse clinical outcomes and higher healthcare utilization compared to non-frequent attenders?
Older frequent ED attenders have significantly higher in-hospital mortality and longer hospital stays compared to non-frequent attenders, highlighting the need for better care coordination.
OBJECTIVE: To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. DESIGN: Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. SETTING: Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. PARTICIPANTS: People aged ≥65 years attending the ED in financial year 2013/2014. MAIN OUTCOME MEASURES: The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. RESULTS: Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. CONCLUSIONS: Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.
Street et al. (Wed,) conducted a cohort in Emergency department attendance (n=21,073). Frequent ED attendance (≥4 ED attendances in 12 months) vs. Non-frequent ED attenders was evaluated on frequent ED use. Frequent ED attendance by older adults was associated with higher in-hospital mortality (7.0% vs 3.2%, P<0.001) and hospital admission (69.2% vs 67.2%, P=0.004) than non-frequent attendance.
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