Article Summary: Identifying older adults with serious, life-limiting illness who would benefit from palliative care or goals-of-care conversations is not simple in the time-pressured ED environment. To tackle this problem, we sought to validate a quick, easy method for engaging emergency clinicians to predict mortality in the ED. Our primary question was, “What is the association of emergency clinicians’ assessment of mortality risk with the actual 1-month mortality among older adults who are admitted to the hospital from the ED?” In this prospective cohort study including 10,737 older adults who visited the emergency department, emergency clinicians’ response of no to the question, “Would you be surprised if your patient died in the next one month?” was associated with 1-month mortality after controlling for confounders. However, the diagnostic test characteristics of the surprise question were poor. Asking emergency clinicians the surprise question may be a valuable tool to identify older patients in the ED with a high risk of 1-month mortality.

Short Bio: Dr. Ouchi is an Assistant Professor of Emergency Medicine at Harvard Medical School and is clinically active as an associate physician in the Emergency Department (ED) and a home hospital physician in the Department of Medicine at Brigham and Women’s Hospital. Dr. Ouchi also services as the Associate Director for the Fellowship in Health Policy Research and Translation. Dr. Ouchi’s research focuses on identifying older adults who would benefit from advance care planning conversations and empowering them to formulate their goals for medical care in the ED. 

Twitter: @KeiO97

Previous AGEM Author Spotlight Articles

August 2019

Managing the Elderly Emergency Department Patient

Shenvi, C. L., & Platts-Mills, T. F. (2019) Annals of Emergency Medicine.

February 2019

Exploring Older Adult ED Fall Patients' Understanding of Their Fall: A Qualitative Study.
Shankar KN, Taylor D, Rizzo CT, Liu SW. Geriatric Orthopaedic Surgery & Rehabilitation. 2017 Dec;8(4):231-237

November 2018
Common Medication Management Approaches for Older Adults in the Emergency Department.
Dresden SM, Allen K, Lyden AE. Clinics in Geriatric Medicine. 2018 Aug;34(3):415-433

April 2018
Telephone Follow‐Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial
Biese KJ, Busby-Whitehead J, Cai J, Stearns SC, Roberts E, Mihas P, Emmet D, Zhou Q, Farmer F, Kizer JS.Journal of the American Geriatrics Society. 2018 March; 66(3): 452-458

March 2018
An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines
Southerland LT, Vargas AJ, Nagaraj L, Gure TR, Caterino JM. Academic Emergency Medicine. 2018 Jan; 25(1): 76-82

February 2018
Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use
Hwang U, Dresden SM, Rosenberg MS, Garrido MM, Loo G, Sze J, Gravenor S, Courtney DM, Kang R, Zhu CW, Vargas-Torres C, Grudzen CR, Richardson LD; GEDI WISE Investigators

January 2018

Major trauma in the older patient: Evolving trauma care beyond management of bumps and bruises
Carpenter CR, Arendts G, Hullick C , Nagaraj, Cooper Z, Burkett E

December 2017

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program
Casey SD, Stevenson DE,  Mumma BE, Slee C, Wolinsky PR, Hirsch CH,Tyler K

November 2017

Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse
Rosen T; Lien C, Stern ME, Bloemen EM, Mysliwiec R, McCarthy TJ, Clark S, Mulcare MR, Ribaudo DS, Lachs MS, Pillemer K, Flomenbaum NE

October 2017

Discrepancies between information provided and information required by emergency physicians for long-term care patients
Evans CS; Timothy Platts-Mills, MD, MSc; Fernandez AR; Grover JM; Cabanas JG; Patel MD; Vilke GM; Brice JH

September 2017

Discrepancies between information provided and information required by emergency physicians for long-term care patients
Parshar R, McLeod S,Don Melady, MSc, MD, 

August 2017

The Effect of Older Age on EMS Use for Transportation to an Emergency Department
Manish N. Shah, MD, MPH; Jones CMC; Wasserman EB, Li T, Amidon A, Abbot, M

July 2017

Serious conditions for ED elderly fall patients: a secondary analysis of the Basel Non-Specific Complaints study
Shan W. Liu MD, SD; Jiraporn Sri-On MD, Gregory Philip Tirrell MS, Christian Nickel MD, Roland Bingisser MD

June 2017

Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department
Jeffrey Caterino, MD; Robert Leininger, MD; David M. Kline, PhD; Lauren T. Southerland, MD; Salman Khaliqdina, MBBS; Christopher W. Baugh, MD, MBA; Daniel J. Pallin, MD, MPH; Kurt B. Stevenson, MD, MPH

May 2017

Factors Associated with Hospital Admission for Older Adults Receiving Care in U.S. Emergency Departments
Alexander X. Lo, MD, PhD; Kellie L. Flood, MD; Kevin Biese, MD, MAT; Timothy F. Platts-Mills, MD, MSc; John P. Donnelly, MSPH; Christoper R. Carpenter, MD, MS

April 2017

Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons
Justine M. Nagurney, MD; William Fleischman, MD, MHS; Ling Han, MD, PhD; Linda Leo-Summers, MPH, Heather G. Allore, PhD; Thomas M. Gill, MD

Improving Pain Relief in Elder Patients (I-PREP): An Emergency Department Education and Quality Intervention
Teresita M. Hogan, MD; Michael D. Howell, MD; John F. Cursio, PhD; Alexandra Wong, BA; William Dale, MD 

March 2017

Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients
Jin H. Han, MD, MSc; Nathan E. Brummel, MD, MSCI; Rameela Chandrasekhar, PhD; Jo Ellen Wilson, MD; Xulei Liu, MS; Eduard E. Vasilevskis, MD, MPH; Timothy D. Girard, MD, MSCI; Maria E. Carlo, MD; Robert S. Dittus, MD, MPH; John F. Schnelle, PhD; E. Wesley Ely, MD, MPH

December 2016

Feasibility of nurses measuring gait speed in older community-dwelling Emergency Department patients
Paula W. Tucker, DNP, FNP-BC; Dian Dowling Evans, PhD, FNP-BC, ENP-BC, FAANP; Carolyn K. Clevenger, DNP, RN, GNP-BC, AGPCNP-BC, FAANP; Michelle Ardisson, DNP, RN, ACNP-BC; Ula Hwang, MD, MPH, FACEP 

October 2013

Geriatric Department Guidelines
Mark S. Rosenberg, DO, MBA, FACEP, Christopher R. Carpenter, MD, MSc, FACEP, Marilyn Bromley, RN, BS, Jeffrey M. Caterino, MD, MPH, FACEP, Audrey Chun, MD, Lowell Gerson, PhD, Jason Greenspan, MD, FACEP, Ula Hwang, MD, FACEP, David P. John, MD, FACEP, Joelle Lichtman, MA, William L. Lyons, MD, Betty Mortensen, RN, MS, BSN, FACHE, Timothy F. Platts-Mills, MD, MSc, Luna C. Ragsdale, MD, MPH, FACEP, Julie Rispoli, David C. Seaberg, MD, CPE, FACEP, Scott T. Wilber, MD, MPH, FACEP