AGEM Author Spotlight Jan 2024

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Published Work by AGEM Member:  
Rachel Skains, MD, MSPH  Assistant Professor of Emergency Medicine at  University of Alabama at Birmingham’s Department of Emergency Medicine

Delirium Due to Potentially Avoidable Hospitalizations Among Older Adults


Delirium is a serious and common complication during acute care hospitalizations in older adults. A substantial percentage of admissions are for ambulatory care sensitive conditions (ACSCs) or potentially avoidable hospitalizations - conditions that might be treated early in the outpatient setting to prevent hospitalization and hospital complications. In our retrospective cross-sectional study at a large Southeastern academic medical center, we found that delirium occurred in 15.6% of admissions for older adults. Delirium rates were lower for ACSC admissions versus admissions for other conditions (13.9% versus 15.8%, p<0.001) but still very substantial. Thus, optimizing treatment of ACSCs in the outpatient setting is an important goal, not only for reducing hospitalizations, but also for reducing risks for hospital-associated complications, such as delirium.


Rachel Michelle Skains, MD, MSPH is an Assistant Professor in the Department of Emergency Medicine (EM) at the University of Alabama at Birmingham (UAB) with a joint faculty position at the Birmingham VA Medical Center (BVAMC). Dr. Skains is an early-stage investigator focused on improving the acute care of older adults through patient-centered outcomes research. After graduating from Wake Forest School of Medicine (2016), she completed her EM residency at UAB (2019) followed by a Clinical Research Fellowship focused on Geriatric EM while pursuing a Master of Science in Public Health (MSPH) in Clinical and Translational Science from the UAB School of Public Health (2021). Dr. Skains was awarded the AHRQ NRSA T32 Postdoctoral Scholar Fellowship (2020-2022), in addition to funding through the UAB Integrative Center for Aging Research (ICAR) and Geriatric Emergency care Applied Research (GEAR) 1.0 pilot grant programs. She has recently been awarded two NIA awards: Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) R03 (2023-2025) and Exploratory/ Developmental Grant R21 (2023-2025). Furthermore, Dr. Skains is a physician champion for the UAB – Highlands and BVAMC Geriatric ED Committees, which received Level 1 (2021) and Level 3 (2023) accreditations respectively, completed the UAB Geriatric Scholar Interprofessional Program (2019-2021), and served as Fellow board member for the GEM Section of ACEP (2021-2023) and currently Chair of the AGEM Grants & Awards Subcommittee (2023-Present). Dr. Skains is also leader of the Medication Safety Committee to update the national Geriatric ED Guidelines 2.0, leader of the CMS quality measure for geriatric high-risk ED prescriptions expert consensus group, and was awarded the 2023 SAEM AGEM Early Career Achievement Award.