Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units

Health Affairs

Volumn 34, Issue 5, 2015, Pages 788-795

  Grudzen, Corita ^a   Richardson, Lynne D ^b   Baumlin, Kevin M ^b   Winkel, Gary ^b   Davila, Carine ^b   Ng, Kristen ^b   Hwang, Ula ^b  

^a BELLEVUE HOSPITAL CENTER   (United States)

^b MOUNT SINAI SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ABDOMINAL PAIN; AGED; ARTICLE; COMORBIDITY; DIZZINESS; DYSPNEA; EMERGENCY CARE; ETHNICITY; FATIGUE; FEMALE; GERIATRIC CARE; HIGH RISK PATIENT; HOSPICE CARE; HOSPITAL ADMISSION; HOSPITAL READMISSION; HUMAN; INTENSIVE CARE UNIT; MAJOR CLINICAL STUDY; MALAISE; MALE; MEDICAID; MEDICARE; NURSE PRACTITIONER; OUTCOME ASSESSMENT; PALLIATIVE THERAPY; RACE DIFFERENCE; THORAX PAIN; VERY ELDERLY; COST CONTROL; ECONOMICS; ELDERLY CARE; EMERGENCY HEALTH SERVICE; HOSPITAL EMERGENCY SERVICE; NEW YORK; NONBIOLOGICAL MODEL; ORGANIZATION AND MANAGEMENT; STATISTICS AND NUMERICAL DATA; UNITED STATES; UNIVERSITY HOSPITAL; UTILIZATION; UTILIZATION REVIEW;

ACADEMIC MEDICAL CENTERS; AGED; AGED, 80 AND OVER; COST SAVINGS; EMERGENCY SERVICE, HOSPITAL; FEMALE; HEALTH SERVICES FOR THE AGED; HUMANS; INTENSIVE CARE UNITS; MALE; MEDICARE; MODELS, ORGANIZATIONAL; NEW YORK CITY; PALLIATIVE CARE; PATIENT READMISSION; TRIAGE; UNITED STATES; UTILIZATION REVIEW;

EID: 84929627248     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2014.0790     Document Type: Article

References (26)

1. Smith AK, McCarthy E, Weber E, Cenzer IS, Boscardin J, Fisher J, et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012;31(6):1277-85.
2. Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-90.
3. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-smallcell lung cancer. N Engl J Med. 2010;363(8):733-42.
4. Penrod JD, Deb P, Dellenbaugh C, Burgess JF Jr, Zhu CW, Christiansen CL, et al. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973-9.
5. Penrod JD, Deb P, Luhrs C, Dellenbaugh C, Zhu CW, Hochman T, et al. Cost and utilization outcomes of patients receiving hospitalbased palliative care consultation. J Palliat Med. 2006;9(4):855-60.
6. Cassel JB, Kerr K, Pantilat S, Smith TJ. Palliative care consultation and hospital length of stay. J Palliat Med. 2010;13(6):761-7.
7. Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75.
8. Mullins PM, Goyal M, Pines JM. National growth in intensive care unit admissions from emergency departments in the United States from 2002 to 2009. Acad Emerg Med. 2013;20(5):479-86.
9. Hwang U, Shah MN, Han JH, Carpenter CR, Siu AL, Adams JG. Transforming emergency care for older adults. Health Aff (Millwood). 2013;32(12):2116-21.
10. Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F,You JJ, et al. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med. 2013;173(9):778-87.
11. Lamba S, DeSandre PL, Todd KH, Bryant EN, Chan GK, Grudzen CR, et al. Integration of palliative care into emergency medicine: the Improving Palliative Care in Emergency Medicine (IPAL-EM) collaboration. J Emerg Med. 2014;46(2):264-70.
12. Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-7.
13. Grudzen CR, Richardson LD, Major-Monfried H, Kandarian B, Ortiz JM, Morrison RS. Hospital administrators' views on barriers and opportunities to delivering palliative care in the emergency department. Ann Emerg Med. 2013;61(6):654-60.
14. Hwang U, Morrison RS. The geriatric emergency department. J Am Geriatr Soc. 2007;55(11):1873-6.
15. Sanon M, Baumlin KM, Kaplan SS, Grudzen CR. Care and Respect for Elders in Emergencies program: a preliminary report of a volunteer approach to enhance care in the emergency department. J Am Geriatr Soc. 2014;62(2):365-70.
16. Hartocollis A. For the elderly, emergency rooms of their own. New York Times. 2012 Apr 9.
17. McCusker J, Bellavance F, Cardin S, Trépanier S. Screening for geriatric problems in the emergency department:reliability and validity. Identification of Seniors at Risk (ISAR) Steering Committee. Acad Emerg Med. 1998;5(9):883-93.
18. McCusker J, Bellavance F, Cardin S, Trépanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999;47(10):1229-37.
19. Dendukuri N, McCusker J, Belzile E. The Identification of Seniors at Risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc. 2004;52(2):290-6.
20. McCusker J, Bellavance F, Cardin S, Belzile E, Verdon J. Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit. Ann Emerg Med. 2000;36(5):438-45.
21. Education in Palliative and End of Life Care. EPEC for emergency medicine [Internet]. Chicago (IL):EPEC; [last updated 2012 Oct 5; cited 2015 Feb 25]. Available from: http:// epec.net/epec_em.php
22. Kelley AS, Back AL, Arnold RM, Goldberg GR, Lim BB, Litrivis E, et al. Geritalk: communication skills training for geriatric and palliative medicine fellows. J Am Geriatr Soc. 2012;60(2):332-7.
23. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676-82.
24. Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med. 2000;7(3):236-42.
25. To access the Appendix, click on the Appendix link in the box to the right of the article online.
26. Pines JM, Mullins PM, Cooper JK, Feng LB, Roth KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc. 2013;61(1):12-7.