As our population gets older and older patients are living longer with more complicated medical problems it is often a challenge to determine which patients should be admitted and which patient should be discharged home. Additional pressures from CMS(Centers for Medicare and Medicaid Services) and health plans’ pressure to discharge patients adds an additional complexity and pressure. A study was published in the March 2016 issue of Annals of Emergency Medicine set out to identify factors that may lead to poor outcomes in elderly patients that present to the emergency department. The study found four factors that indicated that a patient might be at higher risk for death or admission to the ICU within seven days.
Those factors who are high risk if discharged include elderly patients with
- cognitive impairment
- a change in disposition plan from admit to discharge
- low blood pressure
- elevated heart rate
The results come from a matched case-control study of patients age 65 or older who died or were admitted to the ICU within 7 days of being evaluated and discharged from the emergency department.
This study emphasizes the importance of realizing the fragile reality of older patients. There is often pressure by health plans and families to discharge the patient. Physicians must take these factors into account and provide appropriate counseling to patients and families and advocate for patients. This study also emphasizes the point that elderly patients are one of the highest utilizers of emergency services.
The study interestingly came from as study of Kaiser members from Southern California. Hopefully this will be communicated to the physicians who approve of admissions for Kaiser patients and I think this study will allow treating physicians to better advocate for our patients. This study may also alert physicians to risk factors that might cause a catastrophic event