Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review

Suzanne Michelle Rhodes, Asad E Patanwala, Julia Katherine Cremer, Erica Siovhan Marshburn, Michael Herman, Farshad Shirazi, Patricia Harrison-Monroe, Christopher S Wendel, Mindy J Fain, Martha J Mohler, Arthur B Sanders

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - Dec 19 2014

Fingerprint

Medical Records
Hospital Emergency Service
Length of Stay
Health
Confidence Intervals
Comorbidity
Physical Restraint
Electronic Health Records
Quality of Health Care
Population

Keywords

  • Adverse events
  • Boarding
  • Emergency
  • Geriatric psychiatry
  • Length of stay

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{e039135cf022464fb21283942502fe73,
title = "Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review",
abstract = "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.",
keywords = "Adverse events, Boarding, Emergency, Geriatric psychiatry, Length of stay",
author = "Rhodes, {Suzanne Michelle} and Patanwala, {Asad E} and Cremer, {Julia Katherine} and Marshburn, {Erica Siovhan} and Michael Herman and Farshad Shirazi and Patricia Harrison-Monroe and Wendel, {Christopher S} and Fain, {Mindy J} and Mohler, {Martha J} and Sanders, {Arthur B}",
year = "2014",
month = "12",
day = "19",
doi = "10.1016/j.jemermed.2015.06.073",
language = "English (US)",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits

T2 - A Systematic Medical Record Review

AU - Rhodes, Suzanne Michelle

AU - Patanwala, Asad E

AU - Cremer, Julia Katherine

AU - Marshburn, Erica Siovhan

AU - Herman, Michael

AU - Shirazi, Farshad

AU - Harrison-Monroe, Patricia

AU - Wendel, Christopher S

AU - Fain, Mindy J

AU - Mohler, Martha J

AU - Sanders, Arthur B

PY - 2014/12/19

Y1 - 2014/12/19

N2 - 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.

AB - 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.

KW - Adverse events

KW - Boarding

KW - Emergency

KW - Geriatric psychiatry

KW - Length of stay

UR - http://www.scopus.com/inward/record.url?scp=84945544382&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84945544382&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2015.06.073

DO - 10.1016/j.jemermed.2015.06.073

M3 - Article

C2 - 26409675

AN - SCOPUS:84952874357

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

ER -