Older patients who attend outpatient care following an emergency department (ED) visit are less likely to require a return visit to the ED within 30 days, according to results of a study from Advocate Aurora Health researchers published in the Journal of the American Geriatric Society.
“Older adults are among the highest users of the ED, with 60% of older adults discharged home from the ED. Prior research shows that, unlike younger patients, older adults have a much greater risk of adverse events following a visit to an ED,” said Michelle Simpson, PhD, RN, Research Scientist for Advocate Aurora Research Institute and lead author of the article. “By understanding this trend, health systems can design follow-up care solutions to prevent return trips to the ED that can often result in hospital admission and more intensive treatment.”
The study was designed to analyze whether patients ages 65 and older who received a referral, during their ED, visit for post-discharge outpatient care were likely to follow up with outpatient care and if those who did avoided returning to the ED.
The researchers found that among older patients who were discharged from the ED and received a referral for outpatient care but did not follow up with that care, 3.6% returned to the ED within 72 hours and 20% returned within 30 days. In contrast, among older patients who were referred to and attended outpatient care following an ED visit, 2.5% returned to the ED within 72 hours and 16.5% returned within 30 days.
Notably, researchers found that 17% of adults ages 65 and older who were discharged from the ED received a referral to outpatient care, and only 48.4% of those patients attended a follow-up appointment.
“As Americans 65 and older represent a quarter of all ED visits, our findings speak to the need for not only standard referral orders for older adults who are in the ED, but also for interventions to improve referral follow-up,” said Aaron Malsch, MSN, Senior Service Program Manager for Advocate Aurora and coauthor of the article. “Our study did not specifically analyze why patients do not follow up with post-ED outpatient care, however, previous studies have pointed to abrupt or confusing discharge instructions, physical limitations, and a lack of acceptance for follow-up care.”
The investigators suggested more research is needed to determine what interventions might address barriers to outpatient follow-up.
“With 18 geriatric emergency departments, Advocate Aurora is a leader in the field of geriatric care,” said Amit Acharya, PhD, President of the Research Institute and Chief Research Officer and System Vice President for Advocate Aurora. “Studies like this are critical first steps toward improving the health of our older patients and demonstrating how health systems across the country can improve geriatric care.”
To learn more about Advocate Aurora’s research, visit aah.org/research.