Risk screening by the emergency medical services identifies older patients at risk of emergency department readmission: a retrospective observational study

Abstract

Background: Malnutrition, falls, and cognitive impairment are common in older patients visiting the emergency department (ED). Early recognition of these conditions could trigger interventions to improve outcomes following ED visits. Aim: To analyze whether a simple risk screening protocol in the emergency medical services (EMS) identifies older patients at risk of ED readmission. Methods: The EMS screened the falls risk, nutritional risk, and cognition of 472 patients (age ≥ 70 years) transported to the ED of a Finnish secondary care hospital between November 2018 and July 2019. Data on the risk screening, comorbidities, and ED readmissions were collected from electronic patient records. Data were analyzed using negative binomial regression, and the results are presented as incidence rate ratios (IRRs). Results: Altogether 312 patients (66%) experienced 880 ED readmissions during the 12-month follow-up. Nutritional risk was associated with an increased ED readmission rate across all time categories (< 1, 1–3, 3–6, and ≥ 6 months; IRRs 1.36–1.62, p-values < 0.05). Falls risk was associated with ED readmissions from one month after the index ED visit (IRRs 1.41–1.57, p-values < 0.05). Impaired cognition had no effect on readmissions (IRRs 1.14–1.26, p-values > 0.1). Conclusions: Patients with nutritional risk or falls risk, identified by the EMS, had a higher ED readmission rate independent of comorbidity. EMS risk screening could supplement the assessment in the ED to better identify older patients who might benefit from more detailed assessment of their health status and interventions to prevent ED readmission.