Geriatric patients seen by transitional care nurses in the emergency department (ED) are less likely to be admitted to the hospital, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published today in the Journal of the American Geriatrics Society. These findings show that interventions initiated during an older patient’s arrival through the ED can have a significant impact on care.
According to the Emergency Care Research Institute, geriatric adults (65 and older) account for up to 25 percent of all ED visits, but their needs may not be met in a general ED. Programs like the Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements (GEDI WISE) have been developed to meet these challenges. It’s a model used at three large urban hospitals: Mount Sinai Health System in New York City; St. Joseph’s Regional Medical Center in Paterson, New Jersey; and Northwestern Memorial Hospital in Chicago.
GEDI WISE includes an ED-based transitional care nurse program to identify patients with geriatric-specific health needs and coordinate their transition from ED to home. Transitional care nurses include nurse practitioners, ED nurses, and social workers.
In this study, researchers evaluated the effects of transitional care nurses on more than 57,000 patients aged 65 and older who arrived between 2013 and 2015 at all three medical centers. Ten percent of these patients were seen by a transitional care nurse, who assessed for cognitive function, delirium, agitation, functional status, falls risk, and caregiver strain. Their score-based assessment determined the extent of ED care delivered. For any given presentation of symptoms, triage severity, and illness severity, the ED was more likely able to discharge and not admit those patients seen by a transitional care nurse when compared to the same type of patient not seen by such a nurse.
At all three medical centers, individuals who saw a transitional care nurse had on average a 10 percent lower chance of being admitted. At two of the three centers, inpatient admission rates remained lower over the subsequent 30 days for patients treated by a transitional care nurse and discharged from the emergency department.
“These findings will allow hospitals and health care systems to focus on better geriatric emergency care programs for a vulnerable, aging population,” says lead investigator Ula Hwang, MD, Associate Professor of Emergency Medicine and of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “At a time when the national average for emergency department admissions with older adults is on the rise, programs that can reduce hospitalization risk are crucial.”
Hospitalization of older adults carries risks, such as adverse drug effects, falls, cognitive decline, and ulcers. More than 30 percent of older adults develop a hospital-associated disability after an acute admission, and many do not return to their previous functional state.
Additionally, researchers say reducing inpatient admissions of older patients leads to cost savings for hospitals that are moving from a fee-for-service model to value-based care. While hospital admittance is sometimes necessary, health care providers can lower costs by providing the bulk of care in ambulatory clinics or in a patient’s home.
Further study is needed to evaluate ED revisit rates among geriatric patients seen by transitional care nurses.
West Health Institute provided funding support for this research.
The Department of Emergency Medicine at the Mount Sinai Health System is one of the largest in the country and treats more than 600,000 patients annually. The research division is ranked No. 2 in the country in funding from the National Institutes of Health (NIH).
About the Mount Sinai Health System
The Mount Sinai Health System is New York City’s largest integrated delivery system encompassing seven hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai’s vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The System includes approximately 7,100 primary and specialty care physicians; 10 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is ranked No. 18 on U.S. News World Report’s “Honor Roll” of top U.S. hospitals; it is one of the nation’s top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in four other specialties in the 2017-2018 “Best Hospitals” issue. Mount Sinai’s Kravis Children’s Hospital also is ranked in six out of ten pediatric specialties by U.S. News World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and 50th for Ear, Nose, and Throat, while Mount Sinai Beth Israel, Mount Sinai St. Luke’s and Mount Sinai West are ranked regionally. For more information, visithttp://www.mountsinai.org/, or find Mount Sinai on Facebook, Twitter and YouTube.