Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition.

ABSTRACT

BACKGROUND: The Geriatric Emergency Medicine Specialist (GEMS) pilot program is an innovative approach that utilizes geriatric-trained advanced practice providers to facilitate geriatric assessments and care planning for older adults in the emergency department (ED). The objective of this study was to explore the effect of GEMS on the use of observation status and final ED disposition. METHODS: This was a retrospective study under a target trial emulation framework. Geriatric patients (65+ years old) who presented to two ED sites within a large regional healthcare system between December 2020 and December 2022 were included. The primary outcome was final ED disposition (discharge, hospital inpatient admission, or hospital observation admission). Secondary outcomes included ED observation and ED length of stay. Non-GEMS patients were propensity score matched 51 to GEMS patients. Doubly robust regression was used to estimate the odds ratios and 95% confidence intervals of inpatient admission, discharge, hospital observation admission, ED observation admission, and estimate the mean ED length of stay. RESULTS: A total of 427 of 43,064 total patients (1.0%) received a GEMS intervention during the study period. Our analysis included 2,302 geriatric ED patients (410 GEMS, 1,892 non-GEMS) after propensity score matching. Hospital admission rates were 34.1% for GEMS compared to 56.4% for conventional treatment. GEMS patients had decreased odds of inpatient admission (OR 0.41, 95 CI 0.34-0.51, p < 0.001), increased odds of discharge (OR 1.19 95 CI 1.00-1.42, p = 0.047), hospital observation admission (OR 2.97, 95 CI 2.35-3.75, p < 0.001), ED observation admission (OR 4.84 95 CI 3.67-6.38, p < 0.001), and had a longer average ED length of stay (170 min, 95 CI 84.6-256, p < 0.001) compared to non-GEMS patients. CONCLUSIONS: Patients seen by GEMS during their ED visit were associated with higher rates of hospital discharge and lower rates of hospital admissions.