An Emergency Department Observation Unit is a feasible setting for Multidisciplinary Geriatric Assessments in compliance with the Geriatric Emergency Department Guidelines

Abstract

Background

The Geriatric Emergency Department Guidelines recommend providing multidisciplinary geriatric assessment in the Emergency Department (ED), but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED Observation Unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit.

Methods

Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients. Use of any or all of these ancillary consult services could be requested by the Obs Unit physician. A retrospective chart review of random older adult Obs Unit patients was done to assess rates of consult use and interventions by these consulting teams. All patients ≥ 65 years old in our IRB approved, monthly Obs Unit quality database from October 2015 through March 2017 were included.

Results

Our quality database included 221 older patients over 18 months. The average age was 73.3 years (range 65-96) and 55.2% were women. The average observation length of stay was 14.7 hours (±6.5 hours). The majority (74.3%) were discharged from the Obs Unit and 72 hour ED recidivism was 3.6%. Overall, at least one of the multidisciplinary consultant services were requested in 40.3% of patients (n=89). Additional interventions or services were recommended in 80.0% of patients evaluated by physical therapy (32 of 40 patients), 100% of those evaluated by a pharmacist (5 of 5 patients), 38% of those evaluated by case management (27 of 71 patients), and 100% of those evaluated by a geriatrician (8 of 8 patients). Only 5.4% (n=12) of patients were placed in observation specifically for multidisciplinary assessment; these patients had an average length of stay of 12.2 hours and an admission rate of 41.7%.

Conclusions

Incorporating elements of multidisciplinary geriatric assessment for older patients is feasible within an observation time frame and resulted in targeted interventions. An Obs Unit is a reasonable setting to offer services in compliance with the Geriatric ED Guidelines.

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