Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use

Hwang U, Dresden SM, Rosenberg MS, Garrido MM, Loo G, Sze J, Gravenor S, Courtney DM, Kang R, Zhu C, Vargas-Torres C, Grudzen CR, Richardson LD

Contributing GEDC Faculty

Ula Hwang


Dr. Ula Hwang is the Medical Director for Geriatric Emergency Medicine at New York University and a core investigator at the GRECC (Geriatrics Research, Education and Clinical Center) at the James J. Peters Bronx VAMC. Her research focuses on improving the quality of care older adults receive in the ED setting that ranges from observational studies of analgesic safety and effectiveness in older patients to multi-center implementation science studies of geriatric emergency care interventions. Hwang currently co-PIs the Geriatric Emergency Department Collaborative and is the PI on the Geriatric Emergency care Applied Research (GEAR) network.



To examine the effect of an emergency department (ED)‐based transitional care nurse (TCN) on hospital use.


Prospective observational cohort.


Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015.


The intervention was first TCN contact. Controls never saw a TCN during the study period.


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.


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%).


Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.

Full Article at Wiley Online Library

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