Systematic review of Emergency department community transition strategies
Judy Lowthian is a researcher at Monash University’s School of Public Health and Preventive Medicine. Here, she discusses a new systematic review published in Age & Ageing, which looks at various emergency department community transition strategies (ED-CTS) to determine their efficacy.
Emergency Department patients aged 65 years and over are increasing at a faster rate than the ageing population. These older individuals have longer stays in the emergency department and a higher chance of admission due to various psychosocial and medical problems. They also often need increased resources to better comprehend their reason for presentation. Clinicians are also under the strain of meeting time-based targets, managing the flow of the emergency department, maintaining adequate quality of care and accounting for appropriate resource allocation.
An emergency department attendance for the elderly has been described as a ‘sentinel event’, often linked to not only functional decline but paired with other adverse outcomes such as a higher chance of re-presentation. According to literature, 45 per cent of elderly patients are discharged home after presentation to the emergency department. These figures have led to the development of ED-CTS of models of care being implemented within Australia, Canada, the U.S.A and the U.K to assist a safe transition post discharge.
With this in mind, I conducted a systematic review with meta-analysis (alongside my colleagues Rosemary McGinnes, Caroline Brand, Anna Barker and Peter Cameron) as part of a larger project known as the Safe Elderly Emergency Discharge project (SEED). SEED seeks to create the best model of care for the elderly who are discharged from the emergency department.
The outcomes being analysed were unplanned emergency department presentation functional decline, nursing-care home admission and mortality. The extensive search identified five experimental and four observational studies. The ED-CTS in all studies included comprehensive geriatric assessment with referrals for post-discharge community-based assistance.
Only four studies met the criteria for meta-analysis; these determined there were no noticeable benefits for ED-CTS in unplanned emergency department re-attendance, hospital admission or death when compared against usual care. Variability between studies limited the analysis of the effect of ED-CTS on both nursing-care home admission and functional decline.
The authors conclude that there is a paucity of high-quality data to assist consistent and strong recommendations regarding the best method of practice for ED-CTS. This indicates that there is a need for more streamlined incorporation of both clinicians and researchers when developing and evaluating ED-CTS. Furthermore, there needs to be increased rates of reporting such measures and more thorough evaluations of the efficacy of these models of care.