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{
    "pk": 18064,
    "title": "Impact of Geriatric Consult Evaluations on Hospital Admission Rates for Older Adults",
    "subtitle": null,
    "abstract": "Introduction: \nWe examined the impact of a geriatric consult program in the emergency department (ED) and an ED observation geriatric care unit (GCU) setting on hospital admission rates for older ED patients.\nMethods: \nWe performed a retrospective case control study from June 1–August 31, 2019 (pre-program) to September 24, 2019–January 31, 2020 (post-program). Post-program geriatric consults were readily available in the ED and required in the GCU setting. Hospital admission rates (outcome) are reported for patients who received a geriatric consult evaluation (intervention). We analyzed probability of admission using a mixed-effects logistic regression model that included age, gender, recent ED visit, Charlson Comorbidity Index, referral to ED observation, and geriatric consult evaluation as predictor variables.\nResults:\n A total of 9,663 geriatric ED encounters occurred, 4,042 pre-program and 5,621 post-program. Overall, ED admission rates for geriatric patients were similar pre- and post-program (44.8% vs 43.9%, P = 0.39). Of 243 geriatric consults, 149 (61.3%) occurred in the GCU. Overall admission rates post-program for patients receiving geriatric intervention were significantly lower compared to pre-program (23.4% vs 44.9%, P < 0.001). Post-program GCU hospital admission rates were significantly lower than pre-program ED observation unit admission rates (14/149, 9.4%, vs 111/477, 23.3%, P < 0.001). In the logistic regression model, admissions post-program were lower when a geriatric consult evaluation occurred (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.41–0.83). Hospital admissions for older ED observation patients were also significantly decreased when a geriatric consult was obtained (GCU vs pre-program ED observation unit; OR 0.27, 95% CI 0.14–0.50).\nConclusion:\n Geriatric consult evaluations were associated with significantly lower rates of hospital admission and persisted when controlled for age, gender, comorbidities, and ED observation unit placement. This model may allow healthcare systems to decrease potentially avoidable hospital admission rates in older ED patients.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "geriatrics, emergency department, admissions"
        }
    ],
    "section": "Geriatrics",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0jn486s1",
    "frozenauthors": [
        {
            "first_name": "Stephen",
            "middle_name": "",
            "last_name": "Meldon",
            "name_suffix": "",
            "institution": "Cleveland Clinic Emergency Services Institute, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Saket",
            "middle_name": "",
            "last_name": "Saxena",
            "name_suffix": "",
            "institution": "Cleveland Clinic Center for Geriatric Medicine, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Ardeshir",
            "middle_name": "",
            "last_name": "Hashmi",
            "name_suffix": "",
            "institution": "Cleveland Clinic Center for Geriatric Medicine, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Amanda",
            "middle_name": "",
            "last_name": "Masciarelli McFarland",
            "name_suffix": "",
            "institution": "Cleveland Clinic Emergency Services Institute, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "McKinsey",
            "middle_name": "",
            "last_name": "Muir",
            "name_suffix": "",
            "institution": "Cleveland Clinic Emergency Services Institute, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Fernando",
            "middle_name": "",
            "last_name": "Delgado",
            "name_suffix": "",
            "institution": "Cleveland Clinic Emergency Services Institute, Cleveland, Ohio",
            "department": "None"
        },
        {
            "first_name": "Isaac",
            "middle_name": "",
            "last_name": "Briskin",
            "name_suffix": "",
            "institution": "Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, Ohio",
            "department": "None"
        }
    ],
    "date_submitted": "2023-04-11T17:59:04+01:00",
    "date_accepted": "2023-04-11T17:59:04+01:00",
    "date_published": "2023-12-22T21:35:50Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/18064/galley/9208/download/"
        }
    ]
}