Evaluating the impact of an emergency department‐based advanced care unit on admission pathways and outcomes for geriatric patients with acute infection: A retrospective cohort study
Ying Ching Cynthia Wong, Tin Man Hui, Man Ting Lau, Oi Fung Wong, Shing Ko, Ka In Chan, Sau Lai Chan, Yu Tai Chan, Wai Kai ChanAbstract
Introduction
The geographical separation of North Lantau Hospital (NLTH) from its tertiary referral centre, Princess Margaret Hospital (PMH), poses significant challenges for managing critically ill geriatric patients. An Emergency Medicine Advanced Care Unit (EMACU) was established in November 2020 to provide on‐site critical care. This study evaluates the impact of the EMACU on admission pathways and outcomes for geriatric patients with acute infection.
Methods
This single‐centre retrospective cohort study compared pre‐EMACU (2018–2019) and post‐EMACU (2024–2025) eras. The primary outcome was the proportion of critically ill geriatric patients (≥65 years, Triage Categories 1 and 2, infection‐related) transferred to PMH versus admitted to NLTH. Secondary outcomes included admission patterns for moderately ill patients (≥65 years, Triage Category 3, infection‐related), EMACU cohort characteristics and Emergency Medicine Ward (EMW) safety net function.
Results
Geriatric attendance increased from 24,081 to 31,636. For critically ill geriatric patients with acute infection, PMH transfers decreased from 75.8% (94/124) pre‐EMACU to 42.9% (111/259) post‐EMACU, whilst NLTH admissions increased from 24.2% (30/124) to 57.1% (148/259) ( p < 0.001). For moderately ill patients, PMH admissions decreased from 55.3% (1039/1880) to 24.3% (624/2569). Fifty‐one patients were managed in EMACU (28 direct, 23 upgraded); in‐EMW mortality was 29.4% (15/51). Non‐survivors were older, frailer and had higher Acute Physiology and Chronic Health Evaluation II scores. The direct end‐of‐life (EOL) care cohort ( n = 19) was significantly frailer than the EMACU patients.
Conclusion
EMACU implementation was associated with significantly reduced inter‐hospital transfers for geriatric patients with acute infection, whilst facilitating appropriate EOL care differentiation and maintaining patient safety.