119 Polypharmacy and acuity among emergency department short stay unit patients

Abstract

Background Emergency department (ED)-based short-stay units (SSUs) have been implemented globally with the primary scope of accommodating non-emergent, self-care sufficient adult patients who need either diagnostic tests, observation, or short-term treatment. Recently there has been a trend towards admitting patients with more complex disease to SSUs. Mainly because of increasingly overcrowded internal medicine departments. Objectives To investigate and evaluate the current patient clientele at a SSU, with an emphasis on polypharmacy. Methods We conducted a single center SSU point-prevalence study. Data collection included patients’ gender, age, Danish Emergency Process Triage (DEPT) acuity ranking upon admission (in order of decreasing severity: red, orange, yellow, green), primary diagnosis, number of active medications and types of medications. Results Out of 15 patients there were 10 men, mean age 70.3 (±SEM 4.16), and 5 women mean age 68.2 (±SEM 5.86), p=0.775. DEPT acuity ranking among men: 50% yellow, 50% green; among women: 20% orange, 60% yellow, 20% green. The most common diagnoses upon admission were pneumonia (33%), exacerbation of chronic obstructive pulmonary disease (27%), and the need of blood transfusion due to malignancy-induced anemia (20%). 87% of patients had ³ 5 active medications, of these 60% were on paracetamol, 40% were on anti-hypertensives, 27% received antidepressants, 20% were on anti-coagulants. Conclusion Currently other than non-emergent patients are SSU admitted, and polypharmacy is highly prevalent among them. The appropriateness of this development is questionable. A short stay focus may be inappropriate for sorting out polypharmacy in patients with increasingly complex disease.