Abstract
Background
Geriatric medicine in the Emergency Department (ED) represents an advancing field that integrates the principles of geriatric care into urgent care settings. Several studies have evaluated the impact of geriatrician consultations in ED’s on reducing hospital admissions, promoting safe discharges directly from the ED, and ensuring timely admissions to geriatric wards when necessary. However, to our knowledge, there have been no studies to assess the effectiveness of this intervention amongst those patients presenting after falls.
Aim
To evaluate the impact of geriatrician reviews in ED amongst older patients presenting after falls in reducing ED 30-day readmission rates, length of stay (LOS) and disposition.
Methods
A single-centre case control study was undertaken at Monash Medical Centre ED, Victoria. Participants included patients above the age of 65 that presented after a fall from February to August 2022. A total of 1029 patients were identified, out of which 66 cases were seen by geriatricians and 139 controls who received usual care were randomly selected. Retrospective data regarding patient characteristics and outcomes were collected from electronic medical records.
Results
Most patients seen by geriatricians were multi-morbid, frail and had polypharmacy. There was a trend towards reduction in 30-day representation in the geriatrician group compared to control group (6% vs 13%, p>0.05). The geriatrician cohort had a longer LOS in ED (p=0.002). On discharge, 85% of controls were only referred to their primary care providers, whereas 35% of the geriatrician cohort were referred to hospital-led services, 18% to community-led services and 9% to ambulatory admission programmes (p<0.001). 47% of geriatrician cohort were referred to care coordinators compared to 18% of controls (p<0.001).
Conclusions
This study demonstrated that positioning geriatricians at the hospital’s front door enabled early specialist assessment for the more complex and multi-morbid older patients presenting after falls. It also demonstrated effective utilisation of out of hospital-based services and allied health referrals, which is likely to improve patient outcomes and ultimately reduces burden on primary care providers.