Why the study?
It was unknown whether direct admission to geriatric inpatient care from the emergency department was associated with lower length of stay and cost compared with admission through an acute medical unit.
Does direct admission to geriatric inpatient care from the emergency department reduce length of stay and cost compared to admission through an acute medical unit in older patients ≥ 75 years?
Does direct admission to geriatric inpatient care from the emergency department reduce length of stay and cost compared to admission through an acute medical unit in older patients ≥ 75 years?
Direct admission of older adults to geriatric care from the emergency department is associated with shorter length of stay and lower healthcare costs compared to admission via an acute medical unit.
Direct ED-to-geriatric admission was associated with shorter stays and lower costs; hypothesis-generating and should not yet change practice.
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.
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Merchant et al. (2024) studied this question.
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