Outcomes of emergency department observation units for geriatric assessment: a systematic review and meta-analysis

Ageing populations present challenges for emergency departments (EDs), including rising ED attendances among older adults. Geriatric-centred ED observation units (Geri-EDOUs) provide a means of conducting comprehensive geriatric assessment (CGA) with a view to reduce or shorten acute hospitalisations. A systematic review and meta-analysis was conducted to summarise such interventions and evaluate their outcomes.

Seven databases were searched for relevant articles from their dates of inception to 16 December 2024. Articles describing the implementation of Geri-EDOUs with CGA for managing older patients aged 65 years and above were included. Study characteristics and clinical outcomes such as length of stay (LOS), hospital admission, discharge and readmission rates, ED reattendance rates and mortality were narratively synthesised. Meta-analysis was conducted where appropriate.

Fourteen studies were included out of 5656 titles and abstracts screened. We identified three models of Geri-EDOUs, with varied patient profiles and diagnosis categories, unit staffing, patient selection and CGA components. We observed that Geri-EDOUs were associated with shorter LOS and lower hospital admission and readmission rates. Meta-analysis showed a pooled mean LOS of 2.82 days, a mortality rate of 9%, 50% of admissions saved and a 30-day ED readmission rate of 11%. No significant differences in mortality, readmission rates or admissions saved were found in double-arm studies.

Geriatric-centred EDOUs utilise a variety of designs to provide early access to CGA for patients admitted to EDs and demonstrate the potential to improve patient outcomes. Future studies should also consider evaluating patient-reported outcomes and the cost-effectiveness of running Geri-EDOUs.