title: Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay.
abstract: OBJECTIVE
  Senior (geriatric) emergency departments (EDs) are an emerging phenomenon across the United States, designed to provide greater comfort for elders, screening for common morbidities, and selective contact with social workers. We hypothesize that the senior ED will reduce recidivism, rate of admission, and hospital length of stay.
  
  
  METHODS
  This was a pre/postintervention observational study of seniors (≥65 years) before and after opening of a new senior ED in a large community hospital. Older nonseniors treated during the same periods were included to detect temporal trend bias. Outcomes included admission to the hospital, hospital length of stay, and ED return visits. Cox proportional hazards models, controlling for patient age, sex, triage level, insurance type, admission on the index visit, and hospital length of stay, were used to test association with time to return within 30 and 180 days. Multivariable regression modeling was used to determine whether the intervention was associated with admission on the index visit, and hospital length of stay.
  
  
  RESULTS
  There was no significant difference in time to return within 30 days (HR=1.09; 95% confidence interval [CI] 0.95 to 1.23), 180 days (HR=0.99; 95% CI 0.91 to 1.08), or average hospital length of stay. Risk of being admitted on the index visit was lower for seniors treated in the senior ED compared with the regular ED (Relative Risk=0.93; 95% CI 0.89 to 0.98).
  
  
  CONCLUSIONS
  A new senior ED was not associated with reduced ED recidivism or hospital length of stay, but was associated with decreased rate of admission.
authors.affiliation: Saint Joseph Mercy Hospital, Ann Arbor, MI; St. Mary Mercy Hospital, Livonia, MI; University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: keyesdc@trinity-academichealth.org.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Keyes
authors.affiliation: Saint Joseph Mercy Hospital, Ann Arbor, MI.
authors.forename: Bonita
authors.initials: B
authors.lastname: Singal
authors.affiliation: Saint Joseph Mercy Hospital, Ann Arbor, MI.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Kropf
authors.affiliation: Saint Joseph Mercy Hospital, Ann Arbor, MI; University of Michigan School of Medicine, Ann Arbor, MI.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fisk
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005853:Geriatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012737:Sex Factors