ED Discharge Factors Contribute to Outcomes in Older Patients

Seniors discharged from the emergency department (ED) with cognitive impairment, a change in disposition plan, low blood pressure, and elevated heart rate are more likely to be admitted to the intensive care unit (ICU) or to die within 7 days.

Researchers at the University of California Los Angeles (UCLA; USA), Kaiser Permanente Southern California (Pasadena, USA), and other institutions examined 1,442,594 ED visit records among adults over 65 years of age discharged from any of 13 Kaiser Permanente hospitals in 2009-2010, rather than admitted to the hospital. A chart review of 300 randomly chosen patients who were admitted to the ICU or died within 7 days of discharge was then matched to 300 control patients who did not experience the outcome.

Two emergency physicians blinded to study outcomes then reviewed the records and identified several characteristics that were associated with the combined poor outcome. These included a change in disposition plan from admit to discharge (directed by a physician or by the patient leaving the hospital against medical advice), acute or chronic cognitive impairment/mental status changes, and abnormal vital signs (systolic blood pressure below 120 and heart rate above 90). The study was published on March 2, 2016, in Annals of Emergency Medicine.

“Emergency physicians must exercise extra caution when making the decision to admit or discharge a geriatric patient,” said lead author Gelareh Gabayan, MD, MSHS of the department of medicine at UCLA. “These patients tend to be more delicate than their younger counterparts. Even abnormal vital signs, like blood pressure and heart rate, are associated with potentially catastrophic events for patients who are discharged from the ER rather than admitted.”

“Both patient families and hospital administrators can pressure emergency physicians to discharge seniors from the emergency department, but our study supports caution in these decisions,” added Dr. Gabayan. “Our study identifies the patients at risk and the findings show that even seemingly small indicators can add up to something dangerous in these vulnerable patients. It is important to note, however, that this study does not encourage that all older adults be admitted. The findings should act as a tool for emergency department providers.”

Related Links:
University of California Los Angeles
Kaiser Permanente Southern California