Use of Emergency Departments by Frail Elderly Patients: Temporal Patterns and Case Complexity

TL;DR

This study analyzes the temporal patterns and case complexity of frail elderly patients in emergency departments, revealing peak times and higher complexity, to inform staffing and resource allocation.

Contribution

It provides detailed hourly analysis of frail elderly ED arrivals and compares case complexity during different times, addressing gaps in previous coarse time window studies.

Findings

Frail elderly patients arrive more during peak hours, especially midday and afternoon.

Frail patients have higher case complexity than non-frail patients.

Case complexity varies minimally with time, mainly in triage level and ED length of stay.

Abstract

Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients' case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.