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Adverse Health Outcomes After Discharge from the Emergency Department—Incidence and Risk Factors in a Veteran Population

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Abstract

Background

An Emergency Department (ED) visit represents a time of significant risk for an older adult; however, little is known about adverse outcomes after an ED visit in the VA system.

Objectives

1) To describe the frequency and type of adverse health outcomes among older veterans discharged from the ED, and 2) To determine risk factors associated with adverse outcomes.

Design

Retrospective, cohort study at an academically affiliated VA medical center.

Patients

A total of 942 veterans ≥ 65 years old discharged from the ED.

Measurements and Main Results

Primary dependent variable was adverse outcome, defined as a repeat VA ED visit, hospitalization, and/or death within 90 days. Overall, 320 (34.0%) patients experienced an adverse outcome: 245 (26%) returned to the VA ED but were not admitted, 125 (13.3%) were hospitalized, and 23 (2.4%) died. In adjusted analyses, higher score on the Charlson Comorbidity Index (hazard ratio [HR] 1.11; 95% CI 1.03, 1.21), ED visit within the previous 6 months (HR 1.64; 95% CI 1.30, 2.06), hospitalization within the previous 6 months (HR 1.70, 95% CI 1.30, 2.22), and triage to the emergency unit (compared to urgent care clinic) (HR 1.76, 95% CI 1.32, 2.36) were independently associated with higher risk of adverse outcomes.

Conclusion

More than 1 in 3 older veterans discharged from the ED experienced a significant adverse outcome within 90 days of ED discharge. Identifying veterans at greatest risk for adverse outcomes after ED discharge can inform the design and targeting of interventions to reduce morbidity and costs in this group.

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Acknowledgments

The authors gratefully acknowledge support from the following: Duke Aging Center’s John A. Hartford Center of Excellence grant #2002-0269, NIA ID K24-AI-51324-01 and Durham Veterans’ Affairs (VA) Medical Center Geriatrics Research, Education, and Clinical Center (GRECC) and Center for Health Services Research in Primary Care. This research was conducted while Dr. Hastings was supported by a Hartford Geriatrics Health Outcomes Scholar Award from the AGS Foundation for Health in Aging/John A. Hartford Foundation, the VA Special Fellowship in Advanced Geriatrics, and the Duke Aging Center’s John A. Hartford Center of Excellence grant #2006-0109. Dr. Weinberger was supported as a VA HSR&D Career Scientist. The authors also thank Carl Pieper, Dr PH, for statistical advice, Aisha McGriff, BS and Linda Folsom, RN for assistance with data collection, and Karen M. Stechuchak, MS for assistance with VA administrative data files.

Conflicts of interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    S. Nicole Hastings MD & Kenneth E. Schmader MD

  2. Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA

    S. Nicole Hastings MD, Kenneth E. Schmader MD & Richard J. Sloane MPH

  3. Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, NC, USA

    S. Nicole Hastings MD & Kenneth E. Schmader MD

  4. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC, USA

    Morris Weinberger PhD, Kenneth C. Goldberg MD & Eugene Z. Oddone MD, MHS

  5. Department of Health Policy and Administration, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Morris Weinberger PhD

  6. Duke University Medical Center, Room 3502, Blue Zone, Duke South, Box 3003, Durham, NC, 27710, USA

    S. Nicole Hastings MD

Authors
  1. S. Nicole Hastings MD
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  2. Kenneth E. Schmader MD
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  3. Richard J. Sloane MPH
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  4. Morris Weinberger PhD
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  5. Kenneth C. Goldberg MD
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  6. Eugene Z. Oddone MD, MHS
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Corresponding author

Correspondence to S. Nicole Hastings MD.

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Hastings, S.N., Schmader, K.E., Sloane, R.J. et al. Adverse Health Outcomes After Discharge from the Emergency Department—Incidence and Risk Factors in a Veteran Population. J GEN INTERN MED 22, 1527–1531 (2007). https://doi.org/10.1007/s11606-007-0343-9

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  • DOI: https://doi.org/10.1007/s11606-007-0343-9

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