Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Abstract

ObjectivesTo examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DesignProspective observational cohort. SettingThree U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. ParticipantsIndividuals aged 65 and older in the ED (N = 57,287). InterventionThe intervention was first TCN contact. Controls never saw a TCN during the study period. MeasurementsWe examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0-30) and 72-hour ED revisits. ResultsA TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: -9.9% risk of inpatient admission, 95% confidence interval (CI) = -12.3% to -7.5%; site 2: -16.5%, 95% CI = -18.7% to -14.2%; site 3: -4.7%, 95% CI = -7.5% to -2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7-2.3%; site 2: 1.4%, 95% CI = 0.7-2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: -7.8%, 95% CI = -10.3% to -5.3%; site 2: -13.8%, 95% CI = -16.1% to -11.6%). ConclusionTargeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.