Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health−Related Emergency Department Visits: A Systematic Medical Record Review
| Autor: | Erica Siovhan Marshburn, Farshad Shirazi, Asad E. Patanwala, Christopher S. Wendel, Arthur B. Sanders, Michael Herman, Julia Katherine Cremer, Suzanne Michelle Rhodes, Jane Mohler, Mindy J. Fain, Patricia Harrison-Monroe |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Population Medical Records 03 medical and health sciences 0302 clinical medicine Risk Factors Interquartile range Humans Medicine 030212 general & internal medicine education Adverse effect Aged Retrospective Studies Aged 80 and over education.field_of_study business.industry Mental Disorders Medical record 030208 emergency & critical care medicine Retrospective cohort study Emergency department Length of Stay Middle Aged Patient Discharge Confidence interval Logistic Models Emergency medicine Emergency Medicine Female Emergency Service Hospital business Geriatric psychiatry |
| Zdroj: | The Journal of Emergency Medicine. 50:143-152 |
| ISSN: | 0736-4679 |
| DOI: | 10.1016/j.jemermed.2015.06.073 |
| Popis: | Background 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect