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. 2025 Aug;16(4):1537-1549.
doi: 10.1007/s41999-025-01226-8. Epub 2025 May 7.

Evaluation of a care pathway for older adults presenting with nonspecific complaints at the emergency department: a before-and-after study

M G A M van der Velde  1   2 , M A C Jansen  3 , F Derkx-Verhagen  4 , I P B Tournoij  5 , F S Jonkers  6 , H R Haak #  6   7 , M N T Kremers #  7   8
Affiliations

Evaluation of a care pathway for older adults presenting with nonspecific complaints at the emergency department: a before-and-after study

M G A M van der Velde et al. Eur Geriatr Med. 2025 Aug.

Abstract

Purpose: Managing older patients presenting at the Emergency Department (ED) poses challenges due to their predisposition to present with nonspecific complaints (NSC). With an ageing population and ED overcrowding, significance of NSC is expected to grow. Therefore, we implemented a structured care pathway to address the complexity of NSC presentations. The aim of this study is to evaluate the effectivity of this care pathway.

Methods: We conducted a before-and-after study to evaluate the NSC care pathway, which included risk stratification, standardized assessment and diagnostic measurements. A control group receiving standard care was established in two hospitals (hospital 1 and 2) before implementation. Patient enrollment occurred from April 2021 to November 2024. Outcomes included length of stay in the ED (LOS-ED) and in hospital (LOS-H), revisits, diagnostic completeness (i.e. 100% agreement between all ED and hospital discharge diagnoses) and perceived quality of care.

Results: In total, 164 control and 235 intervention patients were included in this study. Median LOS-ED and LOS-H did not show significant differences between the control and intervention patients. Implementation of the care pathway showed non-significant trends towards improved diagnostic completeness (47.1% vs 37.2%, p = 0.096). This might be associated with the non-significant observed decrease in 30-day readmissions (7.5% vs. 12.7%, p = 0.256). Patient-reported outcomes indicated a positive experience with the quality of care.

Conclusion: The care pathway did not improve LOS-ED and LOS-H as hypothesized, possibly due to logistical barriers and patient variability. However, trends suggested improved diagnostic completeness and fewer 30-day readmission rates. Further research initiatives are needed to enhance patient outcomes and care for NSC patients.

Trial registry number: NL8960, date 9-10-2020.

Keywords: Care pathway; Emergency medicine; Nonspecific complaints; Older adults.

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Conflict of interest statement

Declarations. Conflict of interest: None. Ethical approval and consent to participate: This study was approved by the ethics committee at the Máxima Medical Centre in Veldhoven (ref. no N19.034) and by participating hospitals. The ethics committee judged the pathway as standard care; therefore, patients eligible for the pathway were included and asked for informed consent at the end of the ED visit. All participants gave their written informed consent prior to data collection. Dutch Trial register, number NL8960.

Figures

Fig. 1
Fig. 1
Availability of data. Number of patients are presented in total numbers after ‘:’. LOS-ED: length of stay in the ED. LOS-H: length of stay in hospital. 30/90D: 30- and 90-day follow-up. Accuracy: 100% match between the working diagnosis at ED discharge and hospital discharge. Completeness: 100% match between all diagnoses at ED discharge and hospital discharge
See this image and copyright information in PMC

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