Aim
To evaluate the impact of geriatrician reviews in ED amongst elderly patients presenting after falls in reducing ED 30-day readmission rates, length of stay (LOS) and disposition.
Methods
A single-centre case control study was undertaken at Monash Medical Centre ED, Victoria. Participants included patients above the age of 65 that presented after a fall from February to August 2022. A total of 1029 patients were identified, out of which 66 cases were seen by geriatricians and 139 controls were randomly selected. Retrospective data regarding patient characteristics and outcomes were collected from electronic medical records.
Results
Most patients seen by geriatricians were more multi-morbid, frail and had polypharmacy. 13% of patients in the control group re-presented within 30 days, compared to 6% of patients seen by geriatricians, however this was not statistically significant. The geriatrician cohort had a longer LOS in ED (p-value 0.002). On discharge, 85% of controls were referred to primary care providers, whereas 35% of the geriatrician cohort were referred to hospital-led services, 18% to community-led services and 9% to ambulatory admission programmes (p-value of <0.001). 47% of geriatrician cohort were referred to care coordinators compared to 18% of controls (p-value of <0.001).
Conclusions
This study demonstrated that positioning geriatricians at the hospital’s front door enabled early specialist assessment for the more complex and multi-morbid elderly patients presenting after falls. It also demonstrated effective utilisation of out of hospital-based services and allied health referrals, which may improve patient outcomes and ultimately reduces burden on primary care providers.