Evaluation of Stamford Hospital’s Geriatric Emergency Medicine Initiative

The older adult population in the United States is projected to rise by at least 10% by 2030, creating a unique challenge for emergency departments (ED) nationwide. Older adults are more likely to be admitted to the general medical floors and the Intensive Care Unit and experience a higher in-hospital and ED mortality compared to younger populations. To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) ED began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults. Novel processes, geriatric assessments and program metrics are described, as well as descriptive statistics on diagnoses and assessment data. Comparisons between GEMI and non-GEMI cohorts on readmission rates, time-based outcomes, throughput metrics, and other outcomes of interest were compared using chi-square tests and group t-tests. A p-value of 0.05 (p &lt;0.05) defined statistical significance. GEMI-assessed patients had significantly lower readmission rates and length of stay in the hospital and ED compared to the non-GEMI assessed cohort. GEMI patients were more likely to be admitted as observation patients but less likely to return within 72 hours and subsequently admitted to the hospital. GEMI patients commonly presented to the ED for falls, gastrointestinal related issues, and urinary tract infections. The top medications prescribed at discharge included Lipitor, Tylenol, and laxatives. Prior to 2018, SH’s ED did not have a solidified care pathway for geriatric patients and care teams acknowledged a need for change. These results are promising as one of the main goals of the program is to decrease hospital admissions of older adults and reduce the length of stay in the ED to prevent common adverse effects from hospitalization, such as delirium and infections. Our results are dependent on the successful implementation of a unit wide geriatric intervention as well as availability of trained geriatric nurses, optimizing system changes and innovating hospital resources for older adults.<b></b> <b> </b> Keywords: geriatric emergency department, quality improvement, emergency department innovations