Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study

Cyrille P Launay, Kevin Galery, Christine Vilcocq, Marc Afilalo, Olivier Beauchet, Cyrille P Launay, Kevin Galery, Christine Vilcocq, Marc Afilalo, Olivier Beauchet

Abstract

Background: The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers.

Methods: Based on an observational, prospective and longitudinal cohort study 1,800 participants visiting the ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited between September and December 2017. ER2 assessment determined three risk-levels (i.e., low, medium and high) for short-term ED undesirable outcomes. The rate of ER2 digital form completed, the time to fill ER2 items and obtain ER2 risk-levels, the LOS in ED and in hospital, and hospital admission were used as outcomes.

Results: ER2 was usable by ED nurses in charge of older ED users. High-risk group was associated with both increased ED stay (coefficient of regression β = 3.81 with P≤0.001) and hospital stay (coefficient of regression β = 4.60 with P = 0.002) as well as with hospital admission (HR = 1.32 with P≤0.001) when low ER2 risk level was used as referent level. Kaplan-Meier distributions showed that the three risk groups of participants differed significantly (P = 0.001). Those with high-risk level (P≤0.001) were discharged later from hospital to a non-hospital location compared to those with low risk. There was no significant difference between those classified in low-risk and in medium-risk groups (P = 0.985) and those in medium and high-risk groups (P = 0.096).

Conclusion: The ER2 assessment part is usable in daily practice of ED care and its risk stratifications may be used to predict adverse outcomes including prolonged LOS in ED and in hospital as well as hospital admission.

Trial registration: NCT03964311.

Conflict of interest statement

No, the authors have declared that no competing interests exist.

Figures

Fig 1. Evolution of the percentages of…
Fig 1. Evolution of the percentages of ER2 assessment completed (i.e., amount of older ED users with a ER2 score / total amount of older adults who visited ED) from September to December 2017 (n = 1,800).
Fig 2. Evolution of time to fill…
Fig 2. Evolution of time to fill ER2 assessment from September to December 2017 (n = 1,800).
Fig 3. Kaplan-Meier estimates of the probability…
Fig 3. Kaplan-Meier estimates of the probability of discharge from hospital to a non-hospital location based on the ER2 risk-levels (i.e.; low, medium, high) (n = 1,800).

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