Impact of geriatrician presence in emergency care pathway for elderly patients: a comparative study

Background: Elderly individuals constitute approximately 15% of annual emergency department visits, in the South Region. These patients are among the most vulnerable, requiring holistic consideration of somatic, psychological, and social aspects in their management. In 2019, the Emergency Department Refoundation Pact was initiated by the government, leading to the establishment of the Emergency Geriatric Coordination Team (EGCT) at the Martigues Hospital Center (MHC). Objective: Highlight the added value of having a Geriatrician stationed in the Emergency Department pathway of patients aged 75 years old and above admitted to the emergency care department. Methods: An observational, retrospective, comparative, mono-centric study was conducted at MHC. Two cohorts of 200 patients aged 75 years old and above, admitted to the emergency department, were included during two distinct periods before (2019) and after (2022) the establishment of EGCT. Patients were randomly selected and admitted during daytime hours. Results: Following comparative and multivariate analysis, 37.2% reduction in hospitalization rates was observed (Odds ratio 0.113 [0.0594; 0.215], p-value < 0.001), along with a significant decrease in emergency department readmissions at 1 month by 65.5% (Odds ratio 0.124 [0.0516; 0.297], p-value 0.001), and in patient pathway misalignments by 52.5% (Odds ratio 0.365 [0.179; 0.745], p-value 0.00559). Conclusion: The presence of a geriatrician in the emergency department provides added value in the care pathway of patients aged 75 years old and above, through tailored management enabling better identification of frailty factors and geriatric syndromes warranting beneficial hospitalization and decreasing rates of readmissions in emergency department.