EM - ORIGINAL

Internal and Emergency Medicine

, Volume 8, Issue 3, pp 249-254

Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department

  • Glenn ArendtsAffiliated withCentre for Clinical Research in Emergency Medicine (CCREM), Western Australian Institute for Medical ResearchSchool of Primary, Aboriginal and Rural Health Care, University of Western Australia Email author 
  • , Sarah FitzhardingeAffiliated withSchool of Primary, Aboriginal and Rural Health Care, University of Western Australia
  • , Karren PronkAffiliated withSchool of Primary, Aboriginal and Rural Health Care, University of Western Australia
  • , Marani HuttonAffiliated withWestern Australian Department of Health, South Metropolitan Health Service
  • , Yusuf NagreeAffiliated withSchool of Primary, Aboriginal and Rural Health Care, University of Western Australia
  • , Mark DonaldsonAffiliated withDepartment of Geriatric Medicine, Royal Perth Hospital

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Abstract

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation.

Keywords

Emergency department Revisit Risk assessment Discharge planning Allied health personnel