Outcomes in older patients requiring comprehensive allied health care prior to discharge from the emergency department

Abstract

Objectives: There is increasing focus on use of multidisciplinary services within the ED to facilitate discharge of older patients that might otherwise require hospitalisation. The risks associated with this are not well established. We aimed to determine whether older patients requiring allied health-facilitated discharge from the ED were at increased risk of hospital readmission and death after discharge.

Methods: A prospective comparative study with matched controls. Patients aged 65 years and over presenting to the ED underwent risk screening. Those with a positive screen formed the intervention group and received comprehensive allied health input from a care coordination team (CCT) prior to discharge. We prospectively enrolled 1098 patients to the intervention group and matched these 1:1 with controls deemed low risk on risk screening. The primary outcome measure was ED re-attendance within 28 days. Patients were followed up for a minimum of 1 year for other outcomes.

Results: At 28 days, there was a 3% absolute difference in the re-attendance rate to ED (17.9% cases, 14.8% controls, P = 0.05) and no mortality difference (1.4% cases, 1.3% controls, P = 0.85). At 1 year, cases had a higher incidence of unplanned hospitalisation (43.4% vs 29.5%, P < 0.001) but not death (10.7% vs 10.2%, P = 0.66).

Conclusions: Facilitated discharge of selected older adults by a CCT is relatively safe in the short term. Such patients have an increased likelihood of hospitalisation in the year after discharge. The 1 year mortality rate even in a 'low-risk' discharged population is 10%.