Older persons who re-present to the Emergency Department: An observational study

Background: Models of emergent care evolve in response to an ageing population. The Medical Assessment Unit (MAU) receives patients from the Emergency Department (ED) for up to 48 h to facilitate assessment, care and treatment before discharge home or to another inpatient unit. Aim: To describe the clinical and social characteristics of older people who had a stay in the MAU and then re-present to the ED within 28 days of discharge from hospital. Methods: A retrospective observational study design was used. Data were extracted from electronic medical records of older people who re-presented to two public teaching hospital EDs in Queensland, Australia, over a two-week period in 2014. Findings: There were 78 older people who made 84 re-presentations. The average age was 79 years; average number of co-morbidities was seven (range 1-18); almost one-quarter (23%) lived alone; more (63%) were female; half (58%) were married; and one-fifth (20%) had some form of cognitive impairment. Of those who re-presented with the same diagnosis, 46% had cardio-respiratory conditions. One-quarter (28%) of the re-presenters had a discharge summary from the last admission. Discussion: Most of the re-presenters in this study had cardio-respiratory conditions. While a discharge summary was available, it was not consistently completed, raising the importance of discharge summaries as part of continuity across services for older people. Conclusion: How the ED, MAU and primary health services are coordinated bears further investigation. Research into the value of coordination roles, such as nurse navigators, for older people re-presenting to ED is recommended. (C) 2017 Australian College of Nursing Ltd. Published by Elsevier Ltd.