Unplanned early return to the emergency department by older patients: the Safe Elderly Emergency Department Discharge (SEED) project

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Abstract

Background:an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation.

Objectives:to determine factors associated with early re-presentation.

Methods:prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days.

Results: nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) re-presented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for re-presentation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02–3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09–3.90), previous ED visit (OR 2.11, 95% CI 1.43–3.12) and ATS 4 (OR 2.34, 95% CI 1.10–4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70–0.93).

Conclusion: older discharged patients had a high rate of early re-presentation. Previously identified risk factors—increased age, living alone, functional dependence and polypharmacy—were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.

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