Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition

Inessa Cohen; Rohit B Sangal; Richard Andrew Taylor; Anna Crawford; James M Lai; Pamela Martin; Sarah Palleschi; Craig Rothenberg; Debra Tomasino; Ula Hwang

doi:10.1111/jgs.18908

Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition

J Am Geriatr Soc. 2024 Apr 26. doi: 10.1111/jgs.18908. Online ahead of print.

Authors

Inessa Cohen¹, Rohit B Sangal¹, Richard Andrew Taylor^{1

2}, Anna Crawford¹, James M Lai³, Pamela Martin⁴, Sarah Palleschi⁴, Craig Rothenberg¹, Debra Tomasino¹, Ula Hwang^{1

5}

Affiliations

¹ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
² Section for Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Division of Geriatrics and Palliative Care, Department of Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA.
⁴ Department of Internal Medicine and Geriatrics, Yale School of Medicine, New Haven, Connecticut, USA.
⁵ Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.

PMID: 38667266
DOI: 10.1111/jgs.18908

Abstract

Background: The Geriatric Emergency Medicine Specialist (GEMS) pilot program is an innovative approach that utilizes geriatric-trained advanced practice providers to facilitate geriatric assessments and care planning for older adults in the emergency department (ED). The objective of this study was to explore the effect of GEMS on the use of observation status and final ED disposition.

Methods: This was a retrospective study under a target trial emulation framework. Geriatric patients (65+ years old) who presented to two ED sites within a large regional healthcare system between December 2020 and December 2022 were included. The primary outcome was final ED disposition (discharge, hospital inpatient admission, or hospital observation admission). Secondary outcomes included ED observation and ED length of stay. Non-GEMS patients were propensity score matched 5:1 to GEMS patients. Doubly robust regression was used to estimate the odds ratios and 95% confidence intervals of inpatient admission, discharge, hospital observation admission, ED observation admission, and estimate the mean ED length of stay.

Results: A total of 427 of 43,064 total patients (1.0%) received a GEMS intervention during the study period. Our analysis included 2,302 geriatric ED patients (410 GEMS, 1,892 non-GEMS) after propensity score matching. Hospital admission rates were 34.1% for GEMS compared to 56.4% for conventional treatment. GEMS patients had decreased odds of inpatient admission (OR: 0.41, 95 CI: 0.34-0.51, p < 0.001), increased odds of discharge (OR: 1.19 95 CI: 1.00-1.42, p = 0.047), hospital observation admission (OR: 2.97, 95 CI: 2.35-3.75, p < 0.001), ED observation admission (OR: 4.84 95 CI: 3.67-6.38, p < 0.001), and had a longer average ED length of stay (170 min, 95 CI: 84.6-256, p < 0.001) compared to non-GEMS patients.

Conclusions: Patients seen by GEMS during their ED visit were associated with higher rates of hospital discharge and lower rates of hospital admissions.

Keywords: disposition status; emergency department; geriatric assessments.