Tag Archives: emergency department

Physical Therapy in the Emergency Department after a Fall May Help Reduce Future Fall-Related Visits to the Emergency Department

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Journal of the American Geriatrics Society Research Summary

Falls are the leading cause of illness and death among Americans aged 65 and older. In 2014, some 2.8 million older adults visited the emergency department (ED) for a fall-related injury. And over time, the ED visit rate for falls among older adults has grown to 68.8 per 1,000 older adults (as of 2010).

Older adults who visit the ED for a fall are at high risk for both revisiting the ED and dying. In fact, some estimates show that 25 percent of older adults visiting the ED for a fall returned for at least one additional fall-related visit. Fifteen percent of those older adults died within the following year.

Because so many older adults visit an ED due to falls, many experts see an opportunity for EDs to play a role in reducing future falls among older adults who are at high risk.

In a new study, published in the Journal of the American Geriatrics Society, researchers explored whether older adults who received physical therapy (PT) services while in the ED for a fall experienced fewer fall-related repeat visits to the ED.

The research team used Medicare claims data representing Medicare beneficiaries from across the country. The information examined differences in 30-day and 60-day ED repeat visit rates among older adults who visited the ED for a fall and who received PT services in the ED. The researchers compared that to older adults who did not receive PT services in the ED after a fall. Continue reading →

Older Adult-Friendly Emergency Department Staff Help Reduce Hospital Admissions

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JAGS graphicJournal of the American Geriatrics Society Research Summary

When older adults arrive at a hospital’s emergency department (ED), they may face unexpected challenges. For example, they may become less able to function independently. They may develop difficulties thinking and making decisions during or following a visit to the ED. This makes transitions in care to and from the ED an important area for improvement in our health care as we age.

To address these challenges, geriatrics experts have developed special programs such as the “Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements” (GEDI WISE) program. GEDI WISE is an award-winning program that serves as a model for excellence in emergency care for older adults in three large urban hospitals: Mount Sinai Medical Center in New York, NY; St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL.

One piece of the GEDI WISE program includes an ED-based geriatrics transition care nurse (TCN). The TCN identifies patients who have health needs specific to older adults. This nurse works to help people transition to their homes so that they can avoid hospital admission whenever possible.

A team of researchers designed a study to learn how effective the GEDI WISE TCNs were for reducing hospital admissions, later admissions, and revisits to the ED. They published their findings in the Journal of the American Geriatrics Society.

The study took place in 2013-2015 in all three hospitals in the GEDI WISE program. They studied more than 57,000 people aged 65 or older who made more than 120,000 visits to the three participating hospitals’ EDs.

The TCN nurses gave the older adults several different screenings, including tests for:

Informed by these screenings, the TCN used various geriatrics resources to help patients. Some people required only a little support, while others needed extensive help.

Older adults who saw the TCN at least once during the study period were included in the “intervention group.” Older adults who didn’t see the TCN during the study period were included in the “control group.”

Compared to the control group, people who saw the TCN had lower rates of inpatient (hospital or healthcare facility) admissions over 30 days at two of the three hospitals.

The researchers concluded that programs focusing on improving care transitions for older people seen in the ED may help reduce the risk for hospital admission.

This summary is from “Geriatric Emergency Department (ED) Innovations: ED transitional care nurses & hospital utilization.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Ula Hwang, MD, MPH; Scott M. Dresden, MD; Mark S. Rosenberg, DO, MBA; Melissa M. Garrido, PhD; George Loo, DrPh; Jeremy Sze, BS; Stephanie Gravenor, MBA; D. Mark Courtney, MD; Raymond Kang, MA; Carolyn Zhu, PhD; Carmen Vargas-Torres, MS; Corita R. Grudzen, MD, MSHS; Lynne D. Richardson, MD; and the GEDI WISE Investigators.