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
Multicenter Study
. 2020 Jan;27(1):43-53.
doi: 10.1111/acem.13880. Epub 2019 Dec 1.

Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30-day Readmissions for Older Adults

Scott M Dresden  1   2 , Ula Hwang  3   4 , Melissa M Garrido  5 , Jeremy Sze  3 , Raymond Kang  2 , Carmen Vargas-Torres  3 , D Mark Courtney  1 , George Loo  3   6 , Mark Rosenberg  7 , Lynne Richardson  3   6
Affiliations
Free article
Multicenter Study

Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30-day Readmissions for Older Adults

Scott M Dresden et al. Acad Emerg Med. 2020 Jan.
Free article

Abstract

Objectives: Transitional care nurse (TCN) care has been associated with decreased hospitalizations for older adults in the emergency department (ED). The objective of this study was to evaluate the association between TCN care and readmission for geriatric patients who visit the ED within 30 days of a prior hospital discharge.

Methods: We studied a prospective cohort of ED patients aged 65 and older with an ED visit within 30 days of inpatient discharge. Patients with an Emergency Severity Index of 1 or prior TCN contact were excluded. Entropy balancing and logistic regression were used to estimate the average incremental effect of the TCN intervention on risk of admission during the index ED visit and within 30 days of prior discharge.

Results: Of 6,838 visits, 608 included TCN care. TCN patients had lower risk of readmission during the index ED visit at Mount Sinai Medical Center (MSMC), -10.1 percentage points (95% confidence interval [CI] = -18.5 to -2.7), and Northwestern Memorial Hospital (NMH), -17.3 percentage points (95% CI = -23.1 to -11.5), but not St. Joseph's Regional Medical Center (SJRMC), -2.5 percentage points (95% CI = -10.5 to 5.5). TCN patients had fewer readmissions within 30 days of prior hospital discharge at NMH, -16.2 percentage points (95% CI = -22.0 to -10.3), but not at MSMC, -5.6 percentage points (95% CI = -13.1 to 1.8), or at SJRMC, 0.5 percentage points (95% CI = -7.2 to 8.2).

Conclusions: Transitional care nurse care in the ED after a prior hospitalization was associated with decreased readmission of older adults during the index ED visit at two of three hospitals, with sustained reduction for the entire 30-day readmission window at one hospital. TCN interventions in the ED may decrease readmissions for geriatric patients in the ED; however, these results may be dependent on implementation of the program and availability of ED, hospital, and local resources for older adults.

PubMed Disclaimer

References

    1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418-28.
    1. Southern DA, Ngo J, Martin BJ, et al. Characterizing types of readmission after acute coronary syndrome hospitalization: implications for quality reporting. J Am Heart Assoc 2014;3:e001046.
    1. Hines AL, Barrett ML, Jiang HJ, Steiner CA.Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011: Statistical Brief #172. Rockville, MD: Healthcare Cost and Utilization Project (HCUP), 2014.
    1. Report to the Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Commission, 2018.
    1. Šteinmiller J, Routasalo P, Suominen T. Older people in the emergency department: a literature review. Int J Older People Nurs 2015;10:284-305.

Publication types

MeSH terms

LinkOut - more resources