Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients - an observational study

Abstract

Background: Older patients are at particular risk of experiencing adverse events during hospitalisation. Objective: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal Medicine Department (IMD). Methods: Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014. Medical records were reviewed by independent assessors to detect adverse events according to predefined criteria. The primary outcome was the proportion of patients with an adverse event during and within 30 days after hospitalisation. Secondary outcomes included 90-day mortality, subtypes of adverse events, and timing of adverse events. Adjusted analyses were conducted to correct for potential confounders. Results: Four-hundred-fifty patients, 225 patients in each group, were included. Adverse events were found in 67 (30%) patients in the SSU-group and 90 (40%) patients in the IMD group (Odds Ratio (OR) 0.64 (95% Confidence Interval (95% CI) 0.43-0.94, p = 0.02). The result was unchanged in an analysis adjusted for age, Charlson Comorbidity score, and sex. We found no significant difference in 90-day mortality (OR 0.75, 95% CI 0.41-1.38, p = 0.36). The most common adverse events were transfer during hospitalisation, unplanned readmission, and nosocomial infection. Conclusions: Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department.