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Older people’s emergency department fails to lower hospitalisations but improves waiting times

A separate and dedicated older people’s emergency department (OPED) does not significantly lower the level of hospitalisations compared to the main ED but does reduce the time spent in the department, according to a new study.

Older patients seen at an emergency department (ED), especially those with frailty often have more complex health needs. Consequently, there is a need to examine ways to improve care for such patients within an ED, and one possible solution is the development of a dedicated OPED.

In a recent study published in the Journal of Emergency Medicine, a team based at Norfolk and Norwich University Hospital (NNUH) NHS Foundation Trust looked at patient flow in a dedicated OPED – the first in England – against that of the main ED.

The team retrospectively compared the outcomes for older patients attending the main ED in 2019 against those attending the newly formed dedicated OPED service in 2020.

The primary outcome was the proportion of patients admitted to hospital, but the researchers examined a range of other outcomes including the meeting of England’s four-hour national waiting time target, re-admissions, all-cause 30-day mortality, clinical frailty screening and discharge to the patient’s original place of residence. Multivariable logistic regression was performed to estimate adjusted odds ratios between the two emergency departments.

Older people’s emergency department outcomes

A total of 748 patients with a mean age of 87 years (58.7% female) were included in the retrospective analysis), of whom, 374 were assessed in the OPED.

Clinical assessment in the OPED did not significantly lower the proportion of patients subsequently hospitalised (adjusted odds ratio, aOR = 0.84, 95% CI 0.61 – 1.16). Despite this, there were no significant differences in 30-day mortality (aOR = 1.03, 95% CI 0.54 – 2.00) or in re-admissions within seven days of discharge (aOR = 2.06, 95% CI 0.88 – 4.86).

In contrast, patients seen in the OPED were more likely to meet the national four-hour target (aOR = 3.13, 95% CI 2.29 – 4.29) and for being discharged to their original place of residence (aOR = 1.57, 95% CI 1.02 – 2.41). In addition, patients in the OPED spent significantly less time in the emergency department and were seen more quickly by a clinician (p < 0.001 in both cases).

A tailored environment

An OPED includes adaptations in staffing, physical infrastructure and care delivery interventions, all of which aims to combine multidisciplinary staffing and early frailty assessment within an environment tailored to benefit older frail patients.

Commenting on these findings, Dr Katharina Mattishent, consultant in older people’s medicine at NNUH and clinical lecturer at Norwich Medical School, UEA, said: ‘We have demonstrated that patients seen in our environmentally modified area of the ED, led by consultant geriatricians, were three times more likely to meet the four-hour national target compared with those seen in the main ED. This is an important finding, as increased wait times are associated with increased inpatient length of stay, mortality, hospital admissions, and functional decline in those with cognitive impairment.‘

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