PMID- 26409675 OWN - NLM STAT- MEDLINE DCOM- 20160930 LR - 20220408 IS - 0736-4679 (Print) IS - 0736-4679 (Linking) VI - 50 IP - 1 DP - 2016 Jan TI - Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review. PG - 143-52 LID - S0736-4679(15)00696-4 [pii] LID - 10.1016/j.jemermed.2015.06.073 [doi] AB - BACKGROUND: Behavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care. OBJECTIVE: To characterize older adults with BH-related ED visits and determine risk factors associated with prolonged length of stay (LOS) and adverse events (AEs). METHODS: We performed a retrospective electronic health record review of all patients >/=65 years who presented to our ED from September 2011 to August 2012 for BH-related complaints. Sociodemographic, clinical, and utilization data were tested for association with LOS and AE. RESULTS: The 213 elder BH patients represented 4% of the 5267 total elder visits during the study period. Median age was 75 (interquartile range [IQR] 70-82); largely white (84.5%), female (58.7%), and non-Hispanic (69.5%). There was a median of two comorbidities (IQR 1-3), and 46.9% were cognitively impaired. Most (71.5%) were being evaluated on an involuntary basis. Median LOS was 16.2 h (IQR 9.7-29.7). Increased LOS was associated with involuntary status (12.4 h, 95% confidence interval [95% CI] 6.4-18.4); use of restraints (11.9 h, 95% CI 5.7-18.2); and failed discharge (28.8 h, 95% CI 21.2-36.6). For every 10 additional hours in the ED, the risk for an AEs (p = .002) or potential AEs (p = .01) increased 20%. CONCLUSION: Elderly ED patients with BH complaints had high rates of cognitive impairment and multiple comorbidities. LOS was prolonged, and there were multiple contributing factors including involuntary status, chemical or physical restraint, and failed discharge. Patients with longer LOS were at increased risk of an AE or potentially AEs. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Rhodes, Suzanne Michelle AU - Rhodes SM AD - Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona. FAU - Patanwala, Asad E AU - Patanwala AE AD - College of Pharmacy, The University of Arizona, Tucson, Arizona. FAU - Cremer, Julia Katherine AU - Cremer JK AD - College of Medicine, The University of Arizona, Tucson, Arizona. FAU - Marshburn, Erica Siovhan AU - Marshburn ES AD - College of Medicine, The University of Arizona, Tucson, Arizona. FAU - Herman, Michael AU - Herman M AD - Department of Pharmacy, Providence St Peters Hospital, Olympia, Washington. FAU - Shirazi, Farshad Mazda AU - Shirazi FM AD - Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Poison & Drug Information Center, College of Pharmacy, The University of Arizona, Tucson, Arizona; Center for Toxicology Pharmacology Education and Research, College of Medicine, The University of Arizona, Phoenix, Arizona. FAU - Harrison-Monroe, Patricia AU - Harrison-Monroe P AD - Arizona Center on Aging, The University of Arizona, Tucson, Arizona; Department of Psychiatry, College of Medicine, The University of Arizona, Tucson, Arizona. FAU - Wendel, Christopher AU - Wendel C AD - Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona. FAU - Fain, Mindy AU - Fain M AD - Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona. FAU - Mohler, Jane AU - Mohler J AD - Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona. FAU - Sanders, Arthur B AU - Sanders AB AD - Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; College of Medicine, The University of Arizona, Tucson, Arizona. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150926 PL - United States TA - J Emerg Med JT - The Journal of emergency medicine JID - 8412174 SB - IM MH - Aged MH - Aged, 80 and over MH - Emergency Service, Hospital/*statistics & numerical data MH - Female MH - Humans MH - Length of Stay/*statistics & numerical data MH - Logistic Models MH - Male MH - Medical Records MH - Mental Disorders/*therapy MH - Middle Aged MH - Patient Discharge/statistics & numerical data MH - Retrospective Studies MH - Risk Factors OTO - NOTNLM OT - adverse events OT - boarding OT - emergency OT - geriatric psychiatry OT - length of stay EDAT- 2015/09/28 06:00 MHDA- 2016/10/01 06:00 CRDT- 2015/09/28 06:00 PHST- 2014/12/19 00:00 [received] PHST- 2015/04/29 00:00 [revised] PHST- 2015/06/25 00:00 [accepted] PHST- 2015/09/28 06:00 [entrez] PHST- 2015/09/28 06:00 [pubmed] PHST- 2016/10/01 06:00 [medline] AID - S0736-4679(15)00696-4 [pii] AID - 10.1016/j.jemermed.2015.06.073 [doi] PST - ppublish SO - J Emerg Med. 2016 Jan;50(1):143-52. doi: 10.1016/j.jemermed.2015.06.073. Epub 2015 Sep 26.