Analysis of patient-related factors associated with post-discharge adverse events in older patients quickly discharged home after emergency department care with no complementary investigations

Background: To investigate factors associated with post-discharge adverse events in older patients discharged after emergency department (ED) care with no complementary investigations (CI)-blood test (BT), X-ray (XR) or both. Methods: We included patients ≥65 years who attended 52 Spanish EDs and were discharged home in ≤12 hours from 01–07 April 2019. The outcomes assessed were post-discharge combined adverse event (CAE) (all-cause ED revisit, hospitalization or death) occurring within the next 30 days. We analyzed whether age, sex, comorbidity, functional capacity, ability to walk, previous falls, dementia, depression and polypharmacy were associated with outcomes, and whether these outcomes differed compared to discharged patients undergoing CI. Results: We identified 4976 patients (mean time in ED: 1.44 hours, 95% confidence interval (CI): 1.41–1.47) and 1048 (21.4%) presented a CAE, associated with increased comorbidity, decreased functional capacity and polypharmacy but not with age. Compared with patients discharged after CI and spending 3.08 (3.05–3.11) hours in the ED, the CAE of patients without CI did not significantly differ (1208 cases, 22.2%, adjusted Hazard ratio (HR): 1.032, 95% CI: 0.949–1.122). Performing BT and XR increased ED time by 2.07 (1.59–2.15) and 0.35 (0.31–0.40) hours, respectively, while the increase when ordering both investigations was 2.23 (2.17–2.31) hours. Conclusions: ED discharge of older patients without CI does not increase risk of post-discharge events or shorten the time in ED. Age is not related to the risk of post-discharge adverse events, but comorbid and dependent patients with polypharmacy should be cautiously considered for being at increased risk of adverse outcomes.

Direct discharge; Emergency department; Older; Revisit; Hospitalization; Death

[1] Perry A, Macias Tejada J, Melady D. An approach to the older patient in the emergency department. Clinics in Geriatric Medicine. 2018; 34: 299–311.

[2] Pinardi E, Ornago AM, Bianchetti A, Morandi A, Mantovani S, Marengoni A, et al. Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy. BMC Emergency Medicine. 2024; 24: 86.

[3] Cohen I, Sangal RB, Taylor RA, Crawford A, Lai JM, Martin P, et al. Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition. Journal of the American Geriatrics Society. 2024; 72: 2017–2026.

[4] Fernández-Montalbán P, Martínez-Flores S, Mir-Montero M, Arribas López JR, Bibiano-Guillén C, Brañas F. Impact of a geriatric intervention based on the comprehensive geriatrics assessment on avoidable admissions in older patients at risk evaluated in the emergency department. Revista Espanola de Geriatria y Gerontologia. 2024; 59: 101512.

[5] Puig-Campmany M, Ris Romeu J. Frail older patients in the emergency department: main challenges. Emergencias. 2022; 34: 415–417.

[6] Fernández Alonso C. On older persons living in residential facilities and their care in emergency health services. Emergencias. 2022; 34: 411–412.

[7] Ghai S, Chassé K, Renaud MJ, Guicherd-Callin L, Bussières A, Zidarov D. Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation. BMC Health Services Research. 2024; 24: 421.

[8] Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, et al. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital—the first step in a participatory design process. BMC Health Services Research. 2024; 24: 511.

[9] Miró O, González Del Castillo J. Collaboration among Spanish emergency departments to promote research: on the creation of the SIESTA (Spanish Investigators in Emergency Situations TeAm) network and the coordination of the UMC-19 (Unusual Manifestations of COVID-19) macroproject. Emergencias. 2020; 32: 269–277.

[10] González Del Castillo J, Miró Ò. Contributions of the Spanish Investigators in the Emergency Situations TeAm network to COVID-19 knowledge: an example of how emergency physicians can lead first-class research. European Journal of Emergency Medicine. 2022; 29: 160–162.

[11] Miró O, González Del Castillo J. SIESTA—the Spanish Investigators in Emergency Situations TeAm—during the COVID-19 pandemic: a summary of results of the network’s first challenge. Emergencias. 2022; 34: 225–227.

[12] Miró O, Jacob J, García-Lamberechts EJ, Piñera Salmerón P, Llorens P, Jiménez S, et al. Sociodemographic characteristics, functional status, and health resource use of older patients treated in Spanish emergency departments: a description of the EDEN cohort. Emergencias. 2022; 34: 418–427.

[13] Martín-Sánchez FJ, Parra Esquivel P, Llopis García G, González Del Castillo J, Rodríguez Adrada E, Espinosa B, et al. Thirty-day outcomes in frail older patients discharged home from the emergency department with acute heart failure: effects of high-risk criteria identified by the DEED FRAIL-AHF trial. Emergencias. 2021; 33: 165–173.

[14] Afonso-Argilés FJ, Comas Serrano M, Blázquez Andión M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, et al. Factors associated with short-term mortality after emergency department care of residents living in aged care homes: findings from the multicenter Caregency study. Emergencias. 2022; 34: 437–443.

[15] Arévalo-Buitrago P, Morales-Cané I, Olivares Luque E, Godino-Rubio M, Rodríguez-Borrego MA, López-Soto PJ. Early detection of risk for clinical deterioration in emergency department patients: validation of a version of the National Early Warning Score 2 for use in Spain. Emergencias. 2022; 34: 452–457.

[16] García-Pérez D. The importance of holistic evaluation of older patients who fall. Emergencias. 2022; 34: 413–414.

[17] Melady D, Perry A. Ten best practices for the older patient in the emergency department. Clinics in Geriatric Medicine. 2018; 34: 313–336.

[18] López-Sáez B, Herranz Martínez S, Campderrich Estrada E. Is a presentation of urinary tract infection and functional decline in the elderly the whole story? Revista Española de Urgencias y Emergencias. 2022; 1: 115–116. (In Spanish)