Ms Debra Berry1,3, Dr Maryann Street1,2,3, Prof Julie Considine1,2,3
1Deakin University, School of Nursing & Midwifery, Geelong, Australia, 2Deakin University: Centre for Quality and Patient Safety, Geelong, Australia, 3Centre for Quality and Patient Safety, Eastern Health Partnership, Box Hill, Australia
Background: Older people are more likely to have repeat Emergency Department (ED) visits and experience adverse outcomes than younger adults. However, the profile of older frequent ED attenders is under-reported. The aim of this study was to describe the characteristics and outcomes of older frequent ED attenders.
Methods: The study population were people aged ≥65 years, attending an Eastern Health ED in the 2013/2014 financial year. This retrospective cohort study used organisational data linkage at patient level to describe the characteristics and outcomes of frequent ED attenders (≥4 attendances/12-months) compared with non-frequent attenders (<4 attendances/12-months).
Results: In twelve months, 21,073 people aged ≥65 years attended the ED: 5.0% (n=1046) had ≥4 visits, accounting for 16.9% (n=5469) of ED presentations. Frequent ED attenders were more likely to be male (51.8% vs 45%, p<0.001), arrive by ambulance (62.2% vs 57.1%, p<0.001), arrive overnight (22.2% vs 19.8%, p<0.001) and be allocated to triage category 2 (20.4% vs 18.1%, p=0.01). The average ED stay was longer for frequent attenders (6.35 vs 5.88 hours; p<0.001). Frequent attenders had more frequent representations to ED within 48 hours (5.9% vs 2.6%, p<0.001) and readmissions to hospital within 30 days (20.8% vs 4.2%, p<0.001) of discharge. The in-hospital mortality rate for older frequent ED attenders was double that of non-frequent attenders (3.2% vs 7.0%, p<0.001).
Conclusions: Older people who frequently attend an ED are more likely to arrive overnight, by ambulance and have high levels of clinical urgency suggesting limited opportunities for their problem to be resolved without ED care. Older frequent ED attenders had worse outcomes (increased in-hospital mortality, ED representations and hospital readmissions) than non-frequent ED attenders.
Implications: Alternative models of care that direct the patient to the specialist care they need rather than accessing specialist care via the ED warrant exploration
Debra is a clinician of over thirty years nursing experience with greater than 21 years working in the specialty of Emergency Nursing. Her current roles are that of Clinical Nurse Specialist in an outer Melbourne metropolitan ED and Research Fellow in a clinical partnership between Eastern Health and Deakin University.