ArticleBMC emergency medicine2025
Association of hospital and health system factors with emergency department length of stay in older adults with dementia.
Article in BMC emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
Funding
Abstract
backgroundPersons living with dementia (PLWD) have longer lengths of stay (LOS) in the Emergency Department (ED), which increases risk of delirium, falls and medication errors. Care of PLWD in the ED is complex and presence of dementia care specialists (geriatrics, neurology, psychiatry) may streamline care. We sought to understand the contribution of health system factors, including presence of dementia care specialists, to LOS among PLWD.
methodsWe linked statewide ED visit data on patients discharged from the ED for Arkansas, Arizona, Florida and Massachusetts from the 2018 Healthcare Cost and Utilization Project State Emergency Department Database to the American Hospital Association Annual Survey and Healthcare Information Technology supplement. We included ED visit records for persons ≥ 65 years with ICD-10 dementia diagnoses. Median LOS was estimated at the hospital level and then used as a dependent measure in hospital-level Poisson multivariable models that conditioned on system characteristics.
resultsWe included 72,083 ED visits resulting in discharge at 225 health systems. Most EDs were in non-governmental, not-for-profit community hospitals (n = 159, 71%). Median patient age was 83 years (IQR 67, 92), females comprised a mean of 64% of visits. Median LOS was 4 h (IQR 3-7), mean LOS was 9.3 h (SD 16.3). Neurology was the most commonly available dementia care service (n = 180, 80%), followed by psychiatric services (n = 139 EDs, 62%) and geriatric services (n = 132, 59%). In Poisson models adjusting for a parsimonious set of co-variates, the presence of geriatric services was associated with a 16% lower mean LOS (IRR 0.84, 95% CI 0.73-0.97), however, this association lost significance in fully adjusted models (IRR 0.87, 95% CI 0.76-1.01).
conclusionsAvailability of geriatric specialty services may offer hospitals an advantage in streamlining ED care for PLWD and in reducing visit length for this complex patient group. These findings reinforce the potential value of the Geriatrics Emergency Department Accreditation programs.
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