The first older people’s emergency department in England was opened at Norfolk and Norwich University Hospital (NNUH) in December 2017 to bring specialists in older people’s medicine to the front doors of the hospital and provide earlier assessment and treatment for patients.

A new study by the hospital and University of East Anglia (UEA) evaluates the outcomes for patients who received treatment in the main emergency department at NNUH and a similar group of patients who were seen in the older people’s emergency department. As well as reducing wait times for the elderly, the initiative also led to a small reduction in patients being admitted to hospital.

The team found that patients managed through the new initiative spent 20-per-cent less time in the older people’s emergency department. They also received a frailty assessment on average within 34 minutes of arrival, compared with 75 minutes in the regular emergency department.

As a result of seeing an older people’s medicine specialist earlier, there were proportionally fewer admissions from the older people’s emergency department (46.1 per cent) compared with the main emergency department (50.3 per cent), although this difference was not statistically significant.

The four-hour A&E waiting time target and the operational standard set in 2010 stated that at least 95 per cent of patients attending A&E should be admitted, transferred or discharged within four hours.

Dr Katharina Mattishent, consultant in older people’s medicine at NNUH and clinical lecturer at UEA’s Norwich Medical School, said the study demonstrated that patients seen in its environmentally modified area of the emergency department, led by consultant geriatricians, were three times more likely to meet the four-hour national target compared with those seen in the main emergency department.

She said: “This is an important finding, as increased wait times are associated with increased inpatient length of stay, mortality, hospital admissions, and functional decline in those with cognitive impairment.

“A dedicated service in the emergency department can shorten the waiting times for clinical assessment of older people, but it’s not clear that this leads to any downstream benefits in reducing likelihood of hospital admission for older patients.”

The ‘Evaluation of first older people’s emergency department in England – a retrospective cohort study’ is published in the Journal of Emergency Medicine.