The Impact of Emergency Department Geriatric Nurse Practitioners on Patient Length of Stay

Limited research exists that examines the impact of geriatric-focused nurse practitioners practicing within United States emergency departments on the reduction of inpatient admission length of stay for older patients. This represents a significant gap in the provision of care. Our study aimed to assess the efficacy of geriatric-focused nurse practitioners' integration into an emergency department setting and the subsequent effect on the length of stay of inpatient hospital admissions.

We conducted a retrospective analysis of medical records for patients aged ≥65 years from a large, private, not-for-profit, urban hospital emergency department. Data on ED encounters were collected from the year 2023 and aggregated based on patients' age, inpatient hospital admission, and whether they were assigned to a geriatric-focused nurse practitioner while in the emergency department. To investigate the differences in inpatient admission length of stay between geriatric patients assessed and treated by geriatric-focused nurse practitioners and those who were not, we needed to establish confounders that could contribute to the patient's length of stay. We conducted a causal effect identification model and identified 4 confounding variables, which were adjusted for during our analysis.

Findings indicated that patients receiving consultations by geriatric-focused nurse practitioners in the emergency department had a statistically significant reduction in their inpatient length of stay. The unadjusted mean admission length of stay reduced to 5.86 days from 7.28 days, with an unadjusted median reduced to 4.63 days from 4.95 days. We used a multivariable linear regression model using log-transformed length of stay adjusted for confusion assessment method score, mobility score, polypharmacy status, and triage acuity. Data showed that geriatric-focused nurse practitioners' consultations with older patients within the emergency department resulted in a 10.3% reduction in admission length of stay (95% CI, 1.95-17.93).

Geriatric-focused nurse practitioners in the emergency department led to a substantial decrease in inpatient lengths of stay.