Aims The Geriatrician in Emergency Department Initiative (GEDI) allows geriatrician led review and management for patients presenting to ED. This study seeks to identify patient characteristics associated with successful diversion from acute inpatient admission and their outcomes.
Methods A single-centre retrospective cohort study utilising the electronic medical record, all patients at a Victorian metropolitan health service seen by a GEDI clinician were screened for unique encounters over a 6-month period. Group allocation comprised binary outcomes of whether admission from ED to an acute inpatient bed was prevented. Patient attributes were assessed and outcomes analysed for associations.
Results Diversion from acute admission was successful in 71.6% (366/511) of patients. Patients in the diversion group were more likely to return to their usual residence (p = .016) and averaged 7.15 days shorter length of stay in the hospital. Re-presentation within 90 days (30.9% vs 31.7%, p = .852) and survival were similar (94.3% vs 93%, p = .089) when comparing the diversion to non-diversion groups. Differing rates of successful diversion from acute admission were observed between two ED sites in this study, and patient clinical frailty was not associated with diversion outcome (p = .438).
Conclusions Successful GEDI diversion can allow prevention of acute hospital admission whilst not associated with adverse increase in patient mortality or re-presentation rates. Patients diverted from acute admission were more likely to maintain their premorbid level of independence and residence regardless of their perceived clinical frailty, and averaged one-week shorter overall length of stay.