Redirection of Urgent Geriatric Care: Diagnostics and Treatment Parallel to the Emergency Department

Objectives: Complex patients in need of an urgent medical assessment can contribute to crowding in the Emergency Department (ED). Optimising access to geriatric expertise for this patient group is known as 'Geriatric Emergency Departments'. Methods: A parallel care pathway was designed to redirect frail older patients to an Urgent Geriatric Care (UGC) service rather than the ED. The UGC has access to the diagnostic facilities of the ED. This descriptive analysis reports on delivered care, diagnostics, admissions rates, discharge policy, and 30-day and 6-month outcomes concerning hospital (re)admissions, ED visits, and mortality. Results: 269 patients were analysed. The median age was 83 years, 68% had polypharmacy, 51% cognitive disorders, and 83% a gait disturbance. A median of four conclusions was drawn per patient. Evaluation at the UGC often leads to medication regimen changes (81%), initiation or expansion of care at home (46%), and initiation of dementia care (18%). The hospital admission rate was 13%; the rate of ED visits within 30 days was 5% and, within 6 months, an additional 16%; the rate of hospital readmissions within 30 days was 7%, and 11% after 6 months. The mortality rates were 9% within 30 days and 12% within 6 months. Conclusions: Evaluation of patients at the UGC led to a high degree of medication regimen changes, initiation of care at home, and multiple conclusions or diagnoses per patient. Readmission or revisiting rates were low. A direct comparison to care delivered at the ED should be made in a future study.