There are four specific signs that doctors must be on the lookout for when they are considering whether or not they need to admit or discharge an older patient from the emergency department, a new study reported.
According to the researchers, doctors should pay attention to disposition changes, mental health statuses, blood pressure levels and heart rates in older patients aged 65 and above who have checked into the ER. The researchers arrived at these four criteria after analyzing the chart reviews of 600 visits to the ER taken from a sample of 1,442,594 ER visits to Kaiser Permanente Southern California from 2009 to 2010.
The team found that older patients who were discharged after changing their disposition from wanting to be admitted to the hospital to wanting a discharge were more likely to be admitted to the intensive care unit (ICU) shortly after their discharge. They also had a higher risk of death. The team found the same increased risk of death and admittance to the ICU in older ED patients who were allowed to leave the ER despite a change in their mental health status, a systolic blood pressure that was higher than 120 mm Hg and a pulse rate that was faster than 90 beats per minute.
"Emergency physicians must exercise extra caution when making the decision to admit or discharge a geriatric patient," Gelareh Gabayan, from the Department of Medicine at the University of California at Los Angeles, said in a news release. "These patients tend to be more delicate than their younger counterparts. Even abnormal vital signs, like blood pressure and heart rate, are associated with potentially catastrophic events for patients who are discharged from the ER rather than admitted."
Gabayan noted that oftentimes emergency doctors might feel pressured to discharge patients, which this study's findings suggested can result in fatal consequences. Instead of succumbing to the pressure, doctors must be more aware of the risks involved specifically for older patients.
"Our study identifies the patients at risk and the findings show that even seemingly small indicators can add up to something dangerous in these vulnerable patients," Gabayan said. "It is important to note, however, that this study does not encourage that all older adults be admitted. The findings should act as a tool for emergency department providers."
The study was published in the Annals of Emergency Medicine.
