An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments

with Cameron Gettel

With over 450 accredited geriatric EDs (GEDs) in the U.S., we now have the chance to obtain the first benchmarks for emergency care process outcomes in GEDs compared with nongeriatric EDs. In this episode of GEMCast, Dr. Christina Shenvi is joined by Dr. Cameron Gettel to discuss his recent work on an article,An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments,” published in Annals of Emergency Medicine. The paper explores the impact of accredited GEDs by comparing geriatric syndrome diagnosis rates and common process outcomes in GEDs and nongeriatric EDs. Cameron Gettel is an Assistant Professor in the Department of Emergency Medicine, a Clinical Investigator at the Yale Center for Outcomes Research and Evaluation, and the Co-Director of the Yale Emergency Scholars Fellowship.

Key Points

  • Diagnosis rates were higher among GEDs than nongeriatric EDs for 3 of the 4 geriatric syndromes of interest: urinary tract infection, dementia, and delirium/altered mental status.
  • GEDs had shorter ED lengths of stay as well as similar discharge and 72-hour revisit rates when compared with nongeriatric EDs.
    • Discharge rates at non-GEDs were 40-50% higher than GEDs for delirium/altered mental status.
  • The majority of GEDs in the sample (and nationally) were level 3 – which indicates interest and entry-level structures, but not the organizational infrastructure and resources to implement complex interventions to improve process outcomes.
  • Focus of future GED outcomes research:
    • Patient-centred outcomes: 4 Ms framework¬† (what matters, medication, mentation, and mobility)
    • Demonstrate Return on Investment (ROI) from a healthcare perspective

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