Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study

Cyrille P Launay; Kevin Galery; Christine Vilcocq; Marc Afilalo; Olivier Beauchet

doi:10.1371/journal.pone.0249882

Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study

PLoS One. 2021 Aug 11;16(8):e0249882. doi: 10.1371/journal.pone.0249882. eCollection 2021.

Authors

Cyrille P Launay^{1

2}, Kevin Galery^{1

2}, Christine Vilcocq^{1

2}, Marc Afilalo³, Olivier Beauchet^{1

4

5

6}

Affiliations

¹ Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
² Centre of Excellence on Longevity of McGill Integrated University Health and social services Network, Quebec, Canada.
³ Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
⁴ Departments of Medicine, University of Montreal, Montreal, Quebec, Canada.
⁵ Research Center of the Geriatric University institute of Montreal, Montreal, Quebec, Canada.
⁶ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

Abstract

Background: The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers.

Methods: Based on an observational, prospective and longitudinal cohort study 1,800 participants visiting the ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited between September and December 2017. ER2 assessment determined three risk-levels (i.e., low, medium and high) for short-term ED undesirable outcomes. The rate of ER2 digital form completed, the time to fill ER2 items and obtain ER2 risk-levels, the LOS in ED and in hospital, and hospital admission were used as outcomes.

Results: ER2 was usable by ED nurses in charge of older ED users. High-risk group was associated with both increased ED stay (coefficient of regression β = 3.81 with P≤0.001) and hospital stay (coefficient of regression β = 4.60 with P = 0.002) as well as with hospital admission (HR = 1.32 with P≤0.001) when low ER2 risk level was used as referent level. Kaplan-Meier distributions showed that the three risk groups of participants differed significantly (P = 0.001). Those with high-risk level (P≤0.001) were discharged later from hospital to a non-hospital location compared to those with low risk. There was no significant difference between those classified in low-risk and in medium-risk groups (P = 0.985) and those in medium and high-risk groups (P = 0.096).

Conclusion: The ER2 assessment part is usable in daily practice of ED care and its risk stratifications may be used to predict adverse outcomes including prolonged LOS in ED and in hospital as well as hospital admission.

Trial registration: NCT03964311.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged, 80 and over
Emergency Service, Hospital / statistics & numerical data*
Female
Hospitalization / statistics & numerical data
Humans
Kaplan-Meier Estimate
Length of Stay / statistics & numerical data
Longitudinal Studies
Male
Prospective Studies
Risk Assessment / methods*
Risk Factors

Associated data

ClinicalTrials.gov/NCT03964311

Grants and funding

The study was self funded by the Centre of Excellence on Longevity, through funds allocated to research by the Foundation of the Jewish General Hospital. The authors received no specific funding for this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.