Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Nov;22(11):1527-31.
doi: 10.1007/s11606-007-0343-9. Epub 2007 Sep 8.

Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population

S Nicole Hastings  1 , Kenneth E Schmader, Richard J Sloane, Morris Weinberger, Kenneth C Goldberg, Eugene Z Oddone
Affiliations

Adverse health outcomes after discharge from the emergency department--incidence and risk factors in a veteran population

S Nicole Hastings et al. J Gen Intern Med. 2007 Nov.

Abstract

Background: An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system.

Objectives: 1) To describe the frequency and type of adverse health outcomes among older veterans discharged from the ED, and 2) To determine risk factors associated with adverse outcomes.

Design: Retrospective, cohort study at an academically affiliated VA medical center.

Patients: A total of 942 veterans > or = 65 years old discharged from the ED.

Measurements and main results: Primary dependent variable was adverse outcome, defined as a repeat VA ED visit, hospitalization, and/or death within 90 days. Overall, 320 (34.0%) patients experienced an adverse outcome: 245 (26%) returned to the VA ED but were not admitted, 125 (13.3%) were hospitalized, and 23 (2.4%) died. In adjusted analyses, higher score on the Charlson Comorbidity Index (hazard ratio [HR] 1.11; 95% CI 1.03, 1.21), ED visit within the previous 6 months (HR 1.64; 95% CI 1.30, 2.06), hospitalization within the previous 6 months (HR 1.70, 95% CI 1.30, 2.22), and triage to the emergency unit (compared to urgent care clinic) (HR 1.76, 95% CI 1.32, 2.36) were independently associated with higher risk of adverse outcomes.

Conclusion: More than 1 in 3 older veterans discharged from the ED experienced a significant adverse outcome within 90 days of ED discharge. Identifying veterans at greatest risk for adverse outcomes after ED discharge can inform the design and targeting of interventions to reduce morbidity and costs in this group.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Time to first adverse event (repeat ED visit, hospitalization or death) following ED discharge.
See this image and copyright information in PMC

References

    1. Cunningham P, May J. Insured Americans drive surge in emergency department visits. Issue Brief #70. October 2003. Center for Studying Health System Change. http://www.hschange.com/CONTENT/613/613.pdf. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1197/j.aem.2006.09.050', 'is_inner': False, 'url': 'https://doi.org/10.1197/j.aem.2006.09.050'}, {'type': 'PubMed', 'value': '17071799', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17071799/'}]}
    2. Wilber ST, Gerson LW, Terrell KM, et al. Geriatric emergency medicine and the 2006 Institute of Medicine Reports from the Committee on the Future of Emergency Care in the US Health System. Acad Emerg Med. 2006;13:1345–51. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1067/mem.2002.121523', 'is_inner': False, 'url': 'https://doi.org/10.1067/mem.2002.121523'}, {'type': 'PubMed', 'value': '11867975', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11867975/'}]}
    2. Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39:238–47. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1111/j.1532-5415.2006.00707.x', 'is_inner': False, 'url': 'https://doi.org/10.1111/j.1532-5415.2006.00707.x'}, {'type': 'PubMed', 'value': '16696754', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16696754/'}]}
    2. Mion L, Odegard PS, Resnick B, et al. Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement. J Am Geriatr Soc. 2006;54(5):849–52. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1046/j.1532-5415.2003.51185.x', 'is_inner': False, 'url': 'https://doi.org/10.1046/j.1532-5415.2003.51185.x'}, {'type': 'PubMed', 'value': '12657078', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12657078/'}]}
    2. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care. J Am Geriatr Soc. 2003;51:549–55. - PubMed

Publication types

MeSH terms