Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

The GEDI WISE Investigators

doi:10.1111/jgs.15235

Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

The GEDI WISE Investigators

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

99 Scopus citations

Abstract

Objectives: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. Design: Prospective observational cohort. Setting: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. Participants: Individuals aged 65 and older in the ED (N = 57,287). Intervention: The intervention was first TCN contact. Controls never saw a TCN during the study period. Measurements: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0–30) and 72-hour ED revisits. Results: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: −9.9% risk of inpatient admission, 95% confidence interval (CI) = −12.3% to −7.5%; site 2: −16.5%, 95% CI = −18.7% to −14.2%; site 3: −4.7%, 95% CI = −7.5% to −2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: −7.8%, 95% CI = −10.3% to −5.3%; site 2: −13.8%, 95% CI = −16.1% to −11.6%). Conclusion: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

Original language	English (US)
Pages (from-to)	459-466
Number of pages	8
Journal	Journal of the American Geriatrics Society
Volume	66
Issue number	3
DOIs	https://doi.org/10.1111/jgs.15235
State	Published - Mar 2018

Funding

Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. The GEDI WISE Investigators include (in addition to the named authors) the following for their contributions to the implementation and clinical care of the GEDI WISE program: Gallane Abraham, James Adams, Amer Aldeen, Cindy Amoko, Kevin Baumlin, Maria Christensen, Nicholas Genes, Marianna Karounos, Sanjeev Malik, Barbara Morano, Denise Nassisi, Gloria Nimo, Joanna M. Ortiz, Laura Rivera-Reyes, Martine Sanon, Richard Schultz, Jason Shapiro, Debra Sumberg, and Gary Winkel. Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055–01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor. Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. Presented at the AcademyHealth Research Meeting (ARM), June 2016, Boston, Massachusetts, and the American College of Emergency Physicians Scientific Assembly Research Forum, October 2016, Las Vegas, Nevada. Conflict of Interest: MSR is a member of the American College of Emergency Physicians board of directors. DMC is president of the Society for Academic Emergency Medicine board of directors. Author Contributions: Hwang, Loo, Sze, Vargas-Torres had access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Hwang, Loo, Garrido, Sze, Vargas-Torres: data analysis. All remaining authors: study concept and design, interpretation of data, preparation of manuscript. Sponsor's Role: Design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were supported by The Gary and Mary West Health Institute. Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055– 01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor.

Keywords

admission
emergency department
transitions of care

ASJC Scopus subject areas

Geriatrics and Gerontology

Access to Document

10.1111/jgs.15235

Cite this

@article{d45deadf88d14f93bd500c11b57cb3f7,

title = "Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use",

abstract = "Objectives: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. Design: Prospective observational cohort. Setting: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. Participants: Individuals aged 65 and older in the ED (N = 57,287). Intervention: The intervention was first TCN contact. Controls never saw a TCN during the study period. Measurements: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0–30) and 72-hour ED revisits. Results: A TCN saw 5,930 (10\%) individuals, 42\% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: −9.9\% risk of inpatient admission, 95\% confidence interval (CI) = −12.3\% to −7.5\%; site 2: −16.5\%, 95\% CI = −18.7\% to −14.2\%; site 3: −4.7\%, 95\% CI = −7.5\% to −2.0\%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5\%, 95\% CI = 0.7–2.3\%; site 2: 1.4\%, 95\% CI = 0.7–2.1\%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: −7.8\%, 95\% CI = −10.3\% to −5.3\%; site 2: −13.8\%, 95\% CI = −16.1\% to −11.6\%). Conclusion: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.",

keywords = "admission, emergency department, transitions of care",

author = "\{The GEDI WISE Investigators\} and Ula Hwang and Dresden, \{Scott M.\} and Rosenberg, \{Mark S.\} and Garrido, \{Melissa M.\} and George Loo and Jeremy Sze and Stephanie Gravenor and Courtney, \{D. Mark\} and Raymond Kang and Zhu, \{Carolyn W.\} and Carmen Vargas-Torres and Grudzen, \{Corita R.\} and Richardson, \{Lynne D.\}",

note = "Funding Information: Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. Funding Information: The GEDI WISE Investigators include (in addition to the named authors) the following for their contributions to the implementation and clinical care of the GEDI WISE program: Gallane Abraham, James Adams, Amer Aldeen, Cindy Amoko, Kevin Baumlin, Maria Christensen, Nicholas Genes, Marianna Karounos, Sanjeev Malik, Barbara Morano, Denise Nassisi, Gloria Nimo, Joanna M. Ortiz, Laura Rivera-Reyes, Martine Sanon, Richard Schultz, Jason Shapiro, Debra Sumberg, and Gary Winkel. Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055–01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor. Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. Presented at the AcademyHealth Research Meeting (ARM), June 2016, Boston, Massachusetts, and the American College of Emergency Physicians Scientific Assembly Research Forum, October 2016, Las Vegas, Nevada. Conflict of Interest: MSR is a member of the American College of Emergency Physicians board of directors. DMC is president of the Society for Academic Emergency Medicine board of directors. Author Contributions: Hwang, Loo, Sze, Vargas-Torres had access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Hwang, Loo, Garrido, Sze, Vargas-Torres: data analysis. All remaining authors: study concept and design, interpretation of data, preparation of manuscript. Sponsor's Role: Design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were supported by The Gary and Mary West Health Institute. Funding Information: Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055– 01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor. Publisher Copyright: {\textcopyright} 2018, Copyright the Authors Journal compilation {\textcopyright} 2018, The American Geriatrics Society",

year = "2018",

month = mar,

doi = "10.1111/jgs.15235",

language = "English (US)",

volume = "66",

pages = "459--466",

journal = "Journal of the American Geriatrics Society",

issn = "0002-8614",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "3",

}

TY - JOUR

T1 - Geriatric Emergency Department Innovations

T2 - Transitional Care Nurses and Hospital Use

AU - The GEDI WISE Investigators

AU - Hwang, Ula

AU - Dresden, Scott M.

AU - Rosenberg, Mark S.

AU - Garrido, Melissa M.

AU - Loo, George

AU - Sze, Jeremy

AU - Gravenor, Stephanie

AU - Courtney, D. Mark

AU - Kang, Raymond

AU - Zhu, Carolyn W.

AU - Vargas-Torres, Carmen

AU - Grudzen, Corita R.

AU - Richardson, Lynne D.

N1 - Funding Information: Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. Funding Information: The GEDI WISE Investigators include (in addition to the named authors) the following for their contributions to the implementation and clinical care of the GEDI WISE program: Gallane Abraham, James Adams, Amer Aldeen, Cindy Amoko, Kevin Baumlin, Maria Christensen, Nicholas Genes, Marianna Karounos, Sanjeev Malik, Barbara Morano, Denise Nassisi, Gloria Nimo, Joanna M. Ortiz, Laura Rivera-Reyes, Martine Sanon, Richard Schultz, Jason Shapiro, Debra Sumberg, and Gary Winkel. Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055–01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor. Dr. Garrido is supported by Department of Veterans Affairs Health Services Research and Development Service Career Development Award 11–201/CDP12–255. Presented at the AcademyHealth Research Meeting (ARM), June 2016, Boston, Massachusetts, and the American College of Emergency Physicians Scientific Assembly Research Forum, October 2016, Las Vegas, Nevada. Conflict of Interest: MSR is a member of the American College of Emergency Physicians board of directors. DMC is president of the Society for Academic Emergency Medicine board of directors. Author Contributions: Hwang, Loo, Sze, Vargas-Torres had access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Hwang, Loo, Garrido, Sze, Vargas-Torres: data analysis. All remaining authors: study concept and design, interpretation of data, preparation of manuscript. Sponsor's Role: Design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were supported by The Gary and Mary West Health Institute. Funding Information: Financial Disclosure: The project described was supported by Department of Health and Human Services, Centers for Medicare and Medicaid Services Grant 1C1CMS331055– 01–00. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centerss for Medicare and Medicaid Services. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor. Publisher Copyright: © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society

PY - 2018/3

Y1 - 2018/3

N2 - Objectives: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. Design: Prospective observational cohort. Setting: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. Participants: Individuals aged 65 and older in the ED (N = 57,287). Intervention: The intervention was first TCN contact. Controls never saw a TCN during the study period. Measurements: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0–30) and 72-hour ED revisits. Results: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: −9.9% risk of inpatient admission, 95% confidence interval (CI) = −12.3% to −7.5%; site 2: −16.5%, 95% CI = −18.7% to −14.2%; site 3: −4.7%, 95% CI = −7.5% to −2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: −7.8%, 95% CI = −10.3% to −5.3%; site 2: −13.8%, 95% CI = −16.1% to −11.6%). Conclusion: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

AB - Objectives: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. Design: Prospective observational cohort. Setting: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. Participants: Individuals aged 65 and older in the ED (N = 57,287). Intervention: The intervention was first TCN contact. Controls never saw a TCN during the study period. Measurements: We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30-day admission (any admission on Days 0–30) and 72-hour ED revisits. Results: A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: −9.9% risk of inpatient admission, 95% confidence interval (CI) = −12.3% to −7.5%; site 2: −16.5%, 95% CI = −18.7% to −14.2%; site 3: −4.7%, 95% CI = −7.5% to −2.0%). Participants with TCN contact had greater risk of a 72-hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: −7.8%, 95% CI = −10.3% to −5.3%; site 2: −13.8%, 95% CI = −16.1% to −11.6%). Conclusion: Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

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KW - emergency department

KW - transitions of care

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ER -

Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Abstract

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