P035: Improving emergency department outcomes for Alberta seniors

Abstract

Introduction: In 2010, Alberta Health Services (AHS) introduced Transition Coordinators (TC), a unique nursing role focused on assessment of elderly patients to support safe discharge home. The objective of this study is to describe patient characteristics to predict safe discharge for seniors (≥65 years of age) and identify barriers that can be used to improve ED outcomes for these patients. Methods: Two trained research assistants conducted a chart review of the TC referral form and the ED Information System (EDIS) for patients seen by TCs between April and June 2017. Information on patient characteristics, existing home care and community services, the index ED visit and subsequent revisits were extracted. Data were entered into a purpose-built database in REDCap. A descriptive analysis was conducted; results are reported as mean ± standard deviation (SD), median (interquartile range [IQR]), or proportions, as appropriate. Results: A total of 1411 patients with TC referral forms were included (779 [55%] female). The majority of these patients were ≥65 (1350 [96%]) with a mean age of 82 ± 9.6. The majority of patients were triaged as a CTAS of 3 (835 [59%]) with the most common reasons for presentation including: shortness of breath (128 [9%]), abdominal pain (94 [6.7%]), and general weakness (81 [5.7%]). Nearly one third of patients (391 [30%]) were already receiving home care services; (96 [7%]) received a new home care referral as a result of their ED visit. Of all the patients, 1111 (79%) had comorbidities (median: 3 [IQR: 1 to 5]). Overall, 38% (n = 536) patients had visited the ED in the 12 months prior to the index with a median of 2 [IQR: 1 to 4) visits. On average, patient's length of stay for their index visits was 12 ± 0.35 hours. Admissions occurred for 599 [42%] patients with delays being common; the mean time between the decision to admit and the patient leaving the ED was 6 hrs ± 0.23. Conclusion: Seniors in the ED are complex patients who experience long lengths of stay and frequent delays in decision-making. Upon discharge, few patients receive referrals to community supports, potentially increasing the likelihood of revisits and readmissions. Future studies should assess whether the presence of TCs is associated with better outcomes in the community.