Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health−Related Emergency Department Visits: A Systematic Medical Record Review

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• 作者：Suzanne Michelle Rhodes ; MD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ; Asad E. Patanwala ; PharmD^§ ; ; Julia Katherine Cremer ; BS^‖ ; Erica Siovhan Marshburn ; BS^‖ ; Michael Herman ; PharmD^¶ ; ; Farshad Mazda Shirazi ; MD ; PhD^&lowast ; ; ^&lowast ; &lowast ; ; ^&dagger ; &dagger ; ; Patricia Harrison-Monroe ; PhD^&Dagger ; ; ^&Dagger ; &Dagger ; ; Christopher Wendel ; MS^&dagger ; ; ^&Dagger ; ; Mindy Fain ; MD^&dagger ; ; ^&Dagger ; ; Jane Mohler ; MPH ; PhD^&dagger ; ; ^&Dagger ; ; Arthur B. Sanders ; MD^&lowast ; ; ^‖
• 关键词：geriatric psychiatry ; boarding ; length of stay ; adverse events ; emergency
• 刊名：Journal of Emergency Medicine
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：50
• 期：1
• 页码：143-152
• 全文大小：613 K

文摘

Behavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care.

Objective

To characterize older adults with BH-related ED visits and determine risk factors associated with prolonged length of stay (LOS) and adverse events (AEs).

Methods

We performed a retrospective electronic health record review of all patients ≥65 years who presented to our ED from September 2011 to August 2012 for BH-related complaints. Sociodemographic, clinical, and utilization data were tested for association with LOS and AE.

Results

The 213 elder BH patients represented 4% of the 5267 total elder visits during the study period. Median age was 75 (interquartile range [IQR] 70−82); largely white (84.5%), female (58.7%), and non-Hispanic (69.5%). There was a median of two comorbidities (IQR 1−3), and 46.9% were cognitively impaired. Most (71.5%) were being evaluated on an involuntary basis. Median LOS was 16.2 h (IQR 9.7−29.7). Increased LOS was associated with involuntary status (12.4 h, 95% confidence interval [95% CI] 6.4−18.4); use of restraints (11.9 h, 95% CI 5.7−18.2); and failed discharge (28.8 h, 95% CI 21.2−36.6). For every 10 additional hours in the ED, the risk for an AEs (p = .002) or potential AEs (p = .01) increased 20%.

Conclusion

Elderly ED patients with BH complaints had high rates of cognitive impairment and multiple comorbidities. LOS was prolonged, and there were multiple contributing factors including involuntary status, chemical or physical restraint, and failed discharge. Patients with longer LOS were at increased risk of an AE or potentially AEs.