Front-loading allied health intervention in the emergency department does not reduce length of stay for admitted older patients

Abstract

Aims: Allied health intervention may play an important role in the timely discharge of older people admitted to hospital. The impact of early allied health intervention on length of stay has not been quantified. We sought to determine whether early allied health intervention conducted in the emergency department (ED) reduces hospital length of stay in older patients admitted with common diagnoses.

Methods: A non-randomised prospective pragmatic study in ED patients aged 65 and over diagnosed with one or more of six conditions (cerebrovascular insufficiency; fractured neck of femur; cardiac failure; myocardial ischaemia; exacerbation of chronic airways disease; respiratory tract infection). Intervention patients receiving comprehensive allied health assessment/intervention by at least one professional working in a care coordination team were compared with patients who underwent no assessment. The primary outcome measure was hospital length of stay measured in hours from commencement of inpatient bed occupancy to discharge or death. A zero truncated negative binomial regression model was used to analyse length of stay while adjusting for covariates.

Results: In 2121 patients and 1451 comparators, there was no difference in length of stay (median 88 vs 87 h) on unadjusted (log-rank p 0.28) or adjusted (IRR 0.97, p 0.32) analysis.

Conclusions: Front loading allied health assessment in ED has no effect on hospital length of stay.