Repeat EMS transports among elderly emergency department patients

Previous studies of repeat care of the elderly have focused on trauma cases only. The purposes of this study were to identify repeat transports of elderly patients to the authors' emergency department (ED) by emergency medical services (EMS), to identify demographics, and to compare chief complaints.

A population-based, retrospective cohort study was conducted. Data for this study were obtained from computerized registration files in an urban, university-affiliated ED with an annual census of approximately 60,000 visits. Patients were included if they were 65 years of age or older and they were transported by EMS in 1997. The repeater group included patients who had one or more EMS transports within the following 12 months. The comparison group was composed of all patients with no further EMS transport within the 12 months after the index visit. Demographics extracted from the database were gender, chief complaint, total number of visits, and time since previous visits. Repeats were characterized by frequency (number of visits in 12 months after the index visit), type (visit for same vs different complaint), and rate (time to the first return visit). Repeaters were defined as more than one visit within a 12-month period. Repeaters were subdivided as follows: "immediate" (within 72 hours), "short-term" (within 2 months), and "long-term" (within 12 months). Chi-square and 95% confidence intervals (95% CIs) were used. A p-value < 0.05 was considered statistically significant.

There were 365 (23%) repeaters and 1,212 (77%) nonrepeaters. Repeaters accounted for 811 (40%) of the total of 2,023 elderly patients transported by EMS. Fifty-seven percent of all elderly patients transported by EMS were female, with no significant difference between the repeaters and nonrepeaters. There were significantly fewer transports for a chief complaint of trauma among the repeaters than among the nonrepeaters (14% vs 26%, diff = 12, 95% CI = 9-15%). Among the 365 repeaters, 186 (51%) had two transports, 92 (15%) had three transports, 36 (10%) had four transports, and 51 (14%) had five or more transports. Of the return transports by repeaters, 40 (12%) were "immediate," 191 (52%) were "short-term," and 134 (36%) were "long-term."

Repeaters accounted for 18% of elderly ED patients transported by EMS and 40% of elderly transports to the authors' ED. There were significantly fewer trauma transports in the repeater group. One-half of the repeaters returned only once in a 12-month period and a third of these occurred more than three months apart. It is important to understand the characteristics of elderly EMS repeaters in order to use this opportunity for intervention.