School of Medicine

With a rapidly growing older adult population in the United States, the importance of age-appropriate care in the emergency department (ED) is becoming increasingly recognized. The University of California, San Diego (UCSD) La Jolla ED has adopted the use of a specialized health and welfare screening and referral system in its Senior Emergency Care Unit (SECU) to address the unique needs of older adult patients. Trained geriatric nurses screen patients and positive screens generate automatic referrals. Between December 1, 2016 and October 31, 2018 a total of 974 eligible patients were screened. Of these, 354 patients had one or more positive screens and received referrals. A retrospective chart review was used to examine clinical and demographic characteristics of patients to evaluate outcomes of the screening and referral system. Statistical analysis include: two sample t-tests to compare average age between groups; chi-square and likelihood ratio tests to compare demographic characteristics in patients who did and did not receive a referral, follow through with referrals, and return to the ED within 30-days; and logistic regression to asses if referral generation or follow-up predicted 30-day return to the ED. Patients receiving one or more referrals were older (M = 80, SD = 9.2) than those who did not receive any referrals [(M = 77, SD = 8.3), t(674) = 5.07, p<0.01] and patients who followed through with referrals were older (M = 81, SD = 9.2) than those who did not attend any referral follow-up [(M = 78, SD = 9.0), t(151) = 2.67, p<0.05]. Patients who were discharged received referrals at higher rates than expected compared to those who were admitted (χ² LR (13) 27.096, p=0.012) and patients reporting Black or African American race attended follow-up at lower than expected rates compared to patients reporting other races (χ² LR (6) =13.575, p= 0.035). Across all referrals, follow-up was less than 50% suggesting a need for quality improvement in the system.