Evaluation of first Older People's Emergency Department in England – a retrospective cohort study

Background: The complexity of older patients along with trends in poorer outcomes in the Emergency Department has prompted research into how Emergency Departments can adapt to meet the needs of an ageing population. A separate Older People's Emergency Department has been proposed to improve care at the front door.

Objective: Compare patient flow in a dedicated Older People's Emergency Department at a University Hospital in Norfolk, United Kingdom, against that of the main Emergency Department.

Methods: We carried out a retrospective cohort study to compare older patients attending the Emergency Department in 2019 against those attending the newly-formed Older People's Emergency Department service in 2020. Multivariable logistic regression was performed to estimate adjusted odds ratios (emergency admissions, meeting England's four-hour national target, re-admissions, all-cause 30-day mortality, clinical frailty screening, and discharge to original place of residence).

Results: Clinical assessment in the Older People's Emergency Department did not significantly lower the proportion of patients admitted to hospital (aOR 0.84 (95% CI 0.61-1.16).  There were significant reductions in overall time spent in the department, time to initial clinician review and time to frailty screening. Patients seen in the Older People's Emergency Department were more likely to meet the national four-hour target and more likely to be discharged to their original place of residence.

Conclusions: Assessment in the Older People's Emergency Department was not associated with a significantly reduced likelihood of hospitalisation. However, patients had a shorter wait for clinical assessment with concomitant reduction in department length of stay.