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Original research
Older medical outliers on surgical wards: impact on 6-month outcomes
  1. Claire Patry1,
  2. Anne Perozziello2,
  3. Clio Pardineille3,
  4. Christiane Aubert1,
  5. Pauline de Malglaive1,
  6. Christophe Choquet4,
  7. Agathe Raynaud-Simon1,5,
  8. Manuel Sanchez1,5
  1. 1 Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
  2. 2 Health Information Management Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
  3. 3 Geriatric Department, Sainte‐Périne University Hospital, Assistance Publqiue - Hopitaux de Paris (APHP), Paris, France
  4. 4 Emergency Department - Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
  5. 5 University of Paris, Paris, France
  1. Correspondence to Dr Manuel Sanchez, Département de Gériatrie–Hôpital Bichat, APHP, Paris 75877, France; manuel.sanchez{at}aphp.fr

Abstract

Background Medical patients are on occasion admitted transiently to surgical wards when more appropriate wards are at capacity, potentially leading to suboptimal care. The aim of this study was to compare 6-month outcomes in older adults diagnosed with medical conditions in the ED then admitted inappropriately to surgical wards (defined as outliers), with outcomes in comparable patients admitted to medical wards (controls).

Methods In a matched cohort study, 100 consecutive medical outliers from the ED aged 75 years and over were matched according to age, sex and diagnosis to 200 controls. Collected data included number of diagnoses reported in acute care, level of patient illness severity, length of stay, mortality and destination of patients discharged from acute care units (home, rehabilitation facility, nursing home or palliative care facility). An assessment was made of patient vital status and living environment (home, nursing home or hospital) at 6 months post-ED admission.

Results Mean age was 85.6 years. The most common ED diagnoses were gait disorders/falls (18%), neurological disorders (17%) and exhaustion (16%). Outliers displayed lower illness severity levels (0.001) and shorter lengths of stay from ED admission to acute care discharge (p=0.040). Subsequent to acute care, outliers were less commonly discharged home (45% vs 59%) and more commonly discharged to rehabilitation facilities (42% vs 28%). At 6 months post-ED admission, multivariable regression analysis showed that outlier status (OR=0.44 (0.25–0.83); p=0.011) and numbers of diagnoses reported in acute care (OR=0.87 (0.76–0.98); p=0.028) were independently associated with lower probability of living at home.

Conclusion Outlying of older patients to surgical wards negatively affects their prospects of living at home at 6 months after hospital admission. Older patients hospitalised via the ED are entitled to appropriate medical care.

  • management
  • emergency department management
  • hospitalisations
  • emergency department utilisation

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author.

https://doi.org/10.1136/emermed-2020-210192

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author.

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    Footnotes

    • Handling editor Mary Dawood

    • Contributors CPat, AP, CPar, CA, PdM, CC, ARS and MS designed the study and researched the data. CPat and MS drafted the manuscript. CPat, ARS, AP and MS participated in the discussion and reviewed/edited the manuscript. CPat is the guarantor of this work and, as such, had full access to the study data in its entirety and takes responsibility for data integrity and data analysis accuracy. All of the authors have approved the current version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.