Discharging older patients from the emergency department effectively: a systematic review and meta-analysis

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Abstract

Background: a decline in health state and re-attendance are common in people aged =65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95 confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95 CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95 CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.
Original languageEnglish
Article numberafv102
Pages (from-to)761 - 770
Number of pages10
JournalAge and Ageing
Volume44
Issue number5
DOIs
Publication statusPublished - 2015

Cite this

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title = "Discharging older patients from the emergency department effectively: a systematic review and meta-analysis",
abstract = "Background: a decline in health state and re-attendance are common in people aged =65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95 confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95 CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95 CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.",
author = "Judy Lowthian and McGinnes, {Rosemary Anna} and Brand, {Caroline Anne} and Anna Barker and Peter Cameron",
year = "2015",
doi = "10.1093/ageing/afv102",
language = "English",
volume = "44",
pages = "761 -- 770",
journal = "Age and Ageing",
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Discharging older patients from the emergency department effectively: a systematic review and meta-analysis. / Lowthian, Judy; McGinnes, Rosemary Anna; Brand, Caroline Anne; Barker, Anna; Cameron, Peter.

In: Age and Ageing, Vol. 44, No. 5, afv102, 2015, p. 761 - 770.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Discharging older patients from the emergency department effectively: a systematic review and meta-analysis

AU - Lowthian, Judy

AU - McGinnes, Rosemary Anna

AU - Brand, Caroline Anne

AU - Barker, Anna

AU - Cameron, Peter

PY - 2015

Y1 - 2015

N2 - Background: a decline in health state and re-attendance are common in people aged =65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95 confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95 CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95 CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.

AB - Background: a decline in health state and re-attendance are common in people aged =65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. Methods: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. Results: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95 confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95 CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95 CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. Conclusions: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.

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U2 - 10.1093/ageing/afv102

DO - 10.1093/ageing/afv102

M3 - Article

VL - 44

SP - 761

EP - 770

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 5

M1 - afv102

ER -