- A retrospective cohort analysis was conducted to evaluate the implementation of a pilot Senior Emergency Department (ED) program at Summa Akron City Hospital, which has 78,000 annual patient visits. - The historical cohort from January 2012 to December 2012 was compared to the pilot Senior ED program cohort from January 2013 to December 2013. - The pilot Senior ED program significantly reduced inpatient admissions from 54% to 49%, significantly increased observation patients from 2.4% to 4.9%, and significantly increased discharges to home by 2.7%. This demonstrates the effectiveness of the program in managing senior patients.

1. S U M M A A K R O N C I T Y H O S P I T A L
Ahmed F. Ozgur and Scott T. Wilber MD, MPH
Department of Emergency Medicine, Summa Akron City Hospital, Akron, OH
Assessing the Effectiveness of the New Senior ED
Project at Summa Akron City Hospital
Abstract
Objectives: To compare the outcomes of patients seen during
a pilot Senior Emergency Department (ED) program to a
historical cohort of geriatric patients receiving usual ED
care.
Methods: We did a retrospective cohort analysis of quality
assurance data to evaluate the implementation of a pilot
Senior ED program at a 78,000 visit hospital ED. The
historical cohort covered 1/23/2012 to 12/31/2012 and pilot
Senior ED program covered 2013. Patients 65 and older
arriving between 8:30 am and 8:30 pm were triaged to a 15
bed Senior ED. Interventions included assessment by an RN
transitional care coordinator, care protocols, education,
pharmacy review and call backs on discharged patients.
Data are presented as means, proportions, differences and
analyzed for statistical significance using the t-test where
p<0.05 is considered significant.
Results: There were 12,503 eligible visits in 2012 and 13,627
eligible visits in 2013. Mean age was 78 years in both
cohorts; 58% were female in 2012 vs 53% in 2013. During
the pilot Senior ED program length of stay was increased
(2012: 287 minutes vs 2013: 298 minutes), admissions were
significantly decreased (54% vs 49%, p=0.000), and
observation patients increased (2.4% vs 4.9% p=0.000).
During the pilot Senior ED program, discharges to home
increased 2.7% (p=0.000).
Conclusions: The pilot Senior ED program reduced inpatient
admissions, increased discharges to home and observations
significantly showing the program’s effectiveness in
managing senior patients.
Importance:
• Due to changes in healthcare over the last decade, the
emergency department is now the major decision maker for
about half of all hospital admissions in the United States.
• Inpatient care is responsible for about 1/3 of healthcare
spending in the United States.
• Emergency departments will increasingly be asked to
participate in reducing the growth of hospital admissions.1
• Not only is the emergency department’s role in the hospital
growing, but also geriatric patients are one of the most
likely groups to be in the emergency department.2
• Thus, the steps we take to care for our geriatric patients
should be of great importance.
Purpose:
• The purpose of this project is to assess the effectiveness of
the new Senior Emergency Department (ED) project at
Summa Akron City Hospital.
• This program was piloted for 2 months in early 2013 and is
being continued based on early analysis of the results.
• The program involves assessment by an RN transitional
care coordinator, care protocols, education, pharmacy
review and call backs on discharged patients.
• The goals of the program are to improve quality and
provide alternatives to hospital admission.
• As expected, inpatient admissions significantly decreased
and the observation patients significantly increased when
the Senior ED program was implemented.
• The length of stay increased from 2012 to 2013. This was
most likely due to the length of stay in January 2013 was
abnormally high.
• Patient satisfaction data of the patients in our study have all
shown a positive trend line from 2012 to 2013. This
demonstrates the Senior ED program has increased the
overall satisfaction of the senior patients.
• In conclusion, the pilot Senior ED program reduced
inpatient admissions, increased observations, and increased
discharges to home significantly demonstrating the
program’s effectiveness in delivering quality care to acutely
ill senior patients.
1. Greenwald P.W., M.E. Stern, T. Rosen, S. Clark, and N. Flomenbaum. 2013.
Trends in short-stay hospitalizations for older adults from 1990 to 2010:
implications for geriatric emergency care. Am. J. Emerg. Med. 32: 311-314.
2. Morganti K. G., S. Bauhoff, J.C. Blanchard, M. Abir, N. Iyer, A.C. Smith, J.V.
Vesely, E.N. Okeke, and A.L. Kellermann. 2013. The evolving role of
emergency departments in the United States. RAND Corporation. viii-ix.
3. Solberg L., G. Mosser, and S. McDonald.1997. The three faces of performance
measurement: improvement, accountability, and research. Jt Comm J Qual
Improv. 23: 135-147.
Introduction
Visit & Patient Satisfaction Data
Conclusions
References
• There were 12,503 and 13,627 eligible ED visits in 2012
and 2013, respectively.
• The mean age was 78 years in both cohorts.
• The subjects were 58% female in 2012 and 53% female in
2013.
• The mean length of stay was 287 minutes and 298 minutes
in 2012 and 2013, respectively.
• Inpatient admissions significantly decreased from 54% in
the historical cohort group to 49% in the pilot senior ED
program (p=0.000).
• Observation patients significantly increased from 2.4% in
the historical cohort group to 4.9% in the pilot senior ED
program (p=0.000).
• Discharges to home significantly increased by 2.7% during
the pilot Senior ED program (p=0.000).
Materials and Methods
Results
• Retrospective cohort analysis of quality assurance data
obtained to evaluate the implementation of a pilot Senior
ED program in the Summa Akron City Hospital ED which
has 78,000 patient visits per year.
• Historical cohort covered 1/01/2012 to 1/22/2013.
• Pilot Senior ED program was implemented from
1/23/2013 to 12/31/2013.
• Subject criteria in our analysis were as follows:
• Summa Akron City Hospital ED patient
• 65 years old and older
• ED arrival between 8:30 am and 8:30 pm.
• Visit data were extracted from Plato 55 to Microsoft Excel
by month from 1/01/2012 to 12/31/2013 for all subjects.
• Hospital campus
• Age
• Sex
• Time in
• Time out
• Length of stay
• Disposition of patient
• Patient satisfaction data were obtained through
administrative databases. The data include overall
satisfaction, how much the staff cared about the patient,
and the likelihood of using the ED again.
• Data are presented as means, proportions, differences and
analyzed for statistical significance using the t-test where
p<0.05 is considered significant.
• Pivot tables were created using Microsoft Excel to illustrate
data.
• This project is being conducted as part of a quality
improvement project, rather than a traditional research
project.
• The approach and measurements for improvement differ
from those required for measuring for accountability or
clinical research.3
• Hypotheses can be adjusted, consistent bias can be
accepted, and small tests of change are sequentially
conducted until the process is improved.
Limitations
• We hypothesize that the Senior ED program will improve
ED quality for senior patients and reduce hospital
admissions.
Hypothesis