Evaluation of Turkey's First Geriatric Emergency Department and Quality Indicators

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The establishment of geriatric emergency departments is recommended for managing medical emergencies in geriatric patients. This study aimed to evaluate the quality indicators of the first geriatric emergency department established in Turkey. Materials and Method: The quality criteria for patient care in the Geriatric Emergency Department at the Antalya Training and Research Hospital Emergency Department, established under the Erasmus + (2020-1-TR01-KA202- 094358) Strategic Partnerships for Vocational Education and Training project, were recorded and evaluated for both the pre- and post-establishment periods. Quality criteria determined by both international standards and the Ministry of Health were used for this comparison. For this purpose, during the period before the establishment of the service, from September 1 to November 1, 2021, 1,516 patients aged 65 and over who presented with non-traumatic reasons and were in triage categories 2–5 were compared with 1,516 geriatric patients in the same triage categories seen after the establishment of the geriatric emergency service between June 1 and August 1, 2023. Results: Following the establishment of the geriatric emergency department, statistically significant improvements were observed in the quality criteria related to the evaluation processes of patients aged 65 and older in the emergency department. In the pre- and post-establishment measurements of the quality criteria for triage categories 2–5, significant reductions were identified in waiting times for examinations (p=0.00), number of requested tests (p=0.00), number of requested imaging studies (p=0.00), number of necessary consultations (p=0.00), duration of stay in the emergency department (p=0.00), and cost per patient (p=0.00). The rate of readmission within 72 h was 3.7% (p=0.27). Conclusion: The development and implementation of a geriatric emergency department model, applied for the first time in our country, have led to significant improvements in quality indicators that objectively evaluate service delivery. The establishment and expansion of geriatric emergency departments, specific to the growing population aged 65 years and older, should be supported and promoted both in our country and worldwide. GERIATRIC EMERGENCY DEPARTMENT QUALITY INTRODUCTION The World Health Organization and United Nations define older individuals as those aged 65 and above (1). According to United Nations reports, the proportion of the older population, which was 10% of the global population in 2022, is expected to increase to 16% by 2050 (2). Furthermore, the percentage of geriatric patients visiting emergency departments (EDs), currently between 15–25%, is anticipated to reach 40% (3). Aging causes a decline in the functional capacity of the organ systems, increasing the risk of multiple diseases and complications (4). An increase in the older population and the number of individuals with multiple diseases has been identified as one of the primary reasons for the increase in ED visits. Research has shown that crowding in EDs leads to a decrease in service quality, delays in treatment initiation, prolonged hospital admissions or discharge times, increased overall costs, and incomplete implementation of clinical guidelines (5). In response to the growing older population and the subsequent need for quality emergency healthcare services, the first "geriatric ED" model was planned in 2009 (6). To address the increasing need for and development of geriatric EDs, the American College of Emergency Physicians, Society for Academic Emergency Medicine, American Geriatrics Society, and Emergency Nurses Association came together in 2014 to define the quality standards and infrastructure for geriatric EDs, thereby initiating the accreditation process. This collaboration provides guidance for the high- quality care of older adults. This study aimed to evaluate the quality indicators of the first geriatric ED established in Turkey. MATERIALS AND METHODS The study was conducted retrospectively at the Emergency Medicine Clinic of Antalya Training and Research Hospital between June 1, 2023, and August 1, 2023. A total of 1,516 individuals aged 65 and above who met the study criteria and presented for non- traumatic reasons were included in the analysis. We have obtained all subjects’ consent to participate. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical trial number: not applicable. Ethics Committee Approval This study was approved by the Clinical Research Ethics Committee of the University of Health Sciences (SBU) Antalya Training and Research Hospital, dated September 7, 2023, with approval number 12/22.. As part of the Erasmus+ project "Safe and Friendly Medicine for Elderly (Safe and Friendly Emergency Department)" (2020-1-TR01-KA202-094358)-Strategic Partnerships for Vocational Education and Training, training was conducted for all physicians, auxiliary healthcare personnel working in the ED, as well as paramedics and healthcare personnel working in ambulances, during May and June 2022. This training, lasting 8 h in total, was provided to 285 healthcare personnel using the team-based learning method under the title "Management of Geriatric Emergency Medical Cases in Pre-Hospital and Emergency Department Settings" (covering topics such as communication with geriatric patients, atypical presentations, pain management, trauma, polypharmacy, abuse, ethics, and transition issues). In addition, a 2-h training session on communication with older patients was provided to all security, secretary, cleaning, and transport staff working in the ED. Thus, emergency healthcare service personnel working in the prehospital field and all healthcare personnel working in the ED were given awareness training regarding geriatric emergency patients, providing them with a unique perspective. Following the training, physical arrangements and separate examination and observation areas were developed for patients categorized as triage levels 2–5 according to a five-level triage scale. Patients aged over 65 years were evaluated in a separate examination area upon arrival at the ED, and those who required follow-up were transferred to a separate observation area. During these arrangements, the American College of Emergency Physicians’ recommendations and standards were considered (such as noise measurement devices, sound isolation curtains, maximum daylight, comfortable patient beds, and additional visual and walking aids). Following the physical and infrastructure changes, the examination, treatment, and follow-up of patients over 65 years of age who presented to the ED for non-traumatic reasons were provided in this area. Patients in triage category 1 and those with life-threatening instability were excluded. Eligibility and Data Collection The following information was collected simultaneously for each patient: age, sex, method of arrival, social living situation, waiting time for examination after registration (in minutes), ISAR score, diagnostic tests requested in the emergency department (ED), use of blood products, placement of a Foley catheter, application of physical restraints, assessment for abuse or neglect, diagnoses made in the ED, consultations requested, time taken to complete consultations, and the outcome of the ED visit. In addition to the final diagnosis, patient conditions were categorized into the following diagnostic groups: cardiovascular, neurological, respiratory, gastrointestinal, renal, infectious, genitourinary, oncological, hematological, and metabolic diseases. Cost-related data for each patient were recorded as the amounts billed to the Social Security Institution and documented in the Hospital Information Management System (HBYS) under medullary billing records. Data on hospital length of stay and 72-hour return rates were collected using the Ministry of Health's e-Nabız system, the Death Information System, and the Hospital Information Management System (HBYS). The quality of care provided to geriatric patients was assessed according to national standards set by the Ministry of Health and relevant international guidelines. Evaluated quality indicators included emergency department (ED) readmissions, ED observation time, the response time of consulting physicians, and primary patient outcomes such as discharge from the ED, in-ED mortality, or admission to a hospital ward or intensive care unit. Data on patients aged over 65 years who presented to the ED for non-traumatic reasons before the establishment of the geriatric ED were collected from the hospital information system, focusing on similar demographic characteristics, and pre-geriatric ED quality criteria were recorded. After the geriatric ED became operational, the same quality criteria were evaluated again and compared. Statistical analysis The data were analyzed using Statistical Package for the Social Sciences (version 23.0) and MedCalc (version 23.110). Numerical data are expressed as medians (interquartile ranges [ 1 IQR]), and frequency data are expressed as percentages. For the comparison of two independent groups, the Mann– Whitney U test was used for numerical data, whereas Pearson’s chi-square and Fisher’s exact tests were used for frequency data. Comparisons of three or more independent groups for frequency data were performed using the multiway chi-square test. If a statistically significant difference was found in the comparison of three or more groups using the multiway chi-square test, the Bonferroni chi-square residual analysis method was used in the post hoc analysis to identify the group responsible for the difference. Normality analysis was conducted using the Kolmogorov–Smirnov test. Logistic regression analysis was used to identify independent variables that were effective in predicting hospital admission. All hypotheses were two-tailed, and the critical alpha value was set to 0.05. RESULTS The study was conducted in the geriatric yellow and green areas of the ED at Antalya Training and Research Hospital. Between June 1, and August 1, 2023, a total of 1,516 individuals aged 65 and above who met the study criteria and presented for non- traumatic reasons were included in the analysis. Of the patients, 703 (46.4%) were men and 813 (53.6%) were women, with an average age of 73 (range 65–100) and an IQR of 68–78. Most patients (92.5%, n = 1,403) presented to the ED as outpatients. Among the patients included in this study, 88.3% (n = 1,338) lived with their family, 11.1% (n = 168) lived alone, and 0.7% (n = 10) lived in nursing homes (Table 1 ). Table 1 Age, Sex, Transfer Method and Social Status of Patients Variable N (%) Age, median (IQR) 73 (68–78) Sex Men 703 (46.4) Women 813 (53.6) Transfer Method Outpatient 1403 (92.5) Ambulance 113 (7.5) Social Status Living with family Living alone Living in a nursing home 1338 (88.3) 168 (11.1) 10 (0.7) IQR, interquartile range. The most frequently requested tests were complete blood count (47.6%, n = 721) and biochemistry (46.4%, n = 703), followed by electrocardiography (31.9%, n = 484). The most frequently requested samples were urine (1.3%, n = 20) and blood (0.4%, n = 6) (Table 2 ). The most commonly requested imaging methods were plain radiography (18.7%, n = 283) and non-contrast computed tomography (CT) (14.6%, n = 221) (Table 2 ) Table 2 Requested Tests in Emergency Department Variable N (%) ECG 484 (31.9) Hemogram 721 (47.6) Biochemistry 703 (46.4) Cardiac Panel 327 (21.6) Other Blood Tests 380 (25.1) Blood Product 13 (0.9) Ultrasound 123 (8.1) Computed Tomography Not taken Non-contrast CT Contrast CT 1234 (81.4) 221 (14.6) 61 ( 4 ) Magnetic Resonance 38 (2.5) X-Ray 283 (18.7) ECG, electrocardiography; CT, computed tomography. In this study, 84.8% of patients (n = 1,285) were discharged from the emergency department (ED) without requiring a consultation, while 15.2% (n = 231) required at least one consultation. The median consultation duration in the ED was 88 minutes (interquartile range [IQR]: 52–142 minutes). Among all patients, 93.4% (n = 1,416) were discharged from the ED, 5.5% (n = 83) were admitted to a hospital ward, and 1.1% (n = 16) were transferred to the intensive care unit (ICU) (Table 3 ). One patient (0.1%) died in the ED. Of those discharged, 8.6% (n = 131) returned to the ED within 72 hours. For admitted patients, the median hospital length of stay was 5 days (IQR: 3–8) (Table 3 ). The median waiting time for examination after registration was 7 minutes (IQR: 0–21), and the median ED length of stay was 70 minutes (IQR: 5–168). The median cost of ED care per patient was 5.9 US dollars (Table 4 ). Table 3 The Patient’s Ending Up, Readmission, Length of Stay and Cost datas Variable N (%) Endedupintheemergency department Discharged 1416 (93.4) Admitted to service 83 (5.5) Admitted to ICU 16 (1.1) Death 1 (0.1) Readmission in 72 h 131 (8.6) Median (IQR) Waiting time for post-registration examination (min) 7 (0–21) Length of stay in the emergency department (min) 70 (5–168) Duration of hospitalization (day)* 5 ( 3 – 8 ) Emergency room cost ( $ ) 5.9 ICU, intensive care unit; IQR, interquartile range. Before the establishment of the geriatric ED, the number of requested tests was 1,087 (71.7%; p = 0.00), whereas in our study, it was 761 (50.2%; p = 0.00). The number of imaging procedures performed was 780 (51.5%; p = 0.00) before and 580 (38.3%; p = 0.00) after the establishment of the geriatric ED. There was a significant decrease in the number of consultations before the geriatric ED was established (16.1% vs. 6.6%; p = 0.00). The waiting time after registration was 20 min (IQR: 7–55) before and 7 min (IQR: 0–21) after the establishment of the geriatric ED. The length of stay in the ED after the establishment of the geriatric ED also showed a significant decrease compared with that before the establishment of the geriatric ED (150 min vs. 70 min; p = 0.00). The cost of care for patients presenting to the emergency department (ED) was calculated using the prevailing exchange rates during the respective study periods. A statistically significant difference was observed when comparing costs before and after the establishment of the geriatric ED. The median cost prior to the implementation was 9.6 USD (IQR: 2.6–17.6; p = 0.00), whereas the median cost after the establishment was 5.9 USD (IQR: 3.07–12.53; p = 0.00). Although there was a reduction in the rate of return to the ED within 72 h, this decrease was not statistically significant (p = 0.27). Table 4 Geriatric Emergency Department Before And After Comparison Variable Beforethe establishment of the geriatric emergency department Afterthe establishment of the geriatric emergency department Difference (%) (% 95 GA) P-value Tests, n (%) 1087 (71.7) 761 (50.2) 21.5 (18–25) 0.00 Imaging, n (%) 780 (51.5) 580 (38.3) 13.2 (9.7–16.7) 0.00 Consultation, n (%) 439 (29) 231 (15.2) 13.8 (10.9–16.7) 0.00 Admitted to hospital, n (%) 244 (16.1) 100 (6.6) 9.5 (7.3–11.8) 0.00 Readmission, n (%) 68 (4.5) 57 (3.7) 4.1 (2.4–5.9) 0.27 Waiting time for post- registration examination (min), median (IQR) 20 (7–55) 7 (0–21) -- 0.00 Length of stay in the emergency department (min), median (IQR) 150 (60–295) 70 (5–168) -- 0.00 Emergency room cost ( $ ), median (IQR) 9.6 $ (25–164) 5.9 $ (80–282) -- 0.00 IQR, interquartile range. DISCUSSION The average age of patients aged 65 and older who presented to our ED for non-traumatic reasons was found to be 73 ± 5 years, with women accounting for 53.6% of the cases. During the same period, it was determined that 14.3% of all patients who presented to the ED were aged 65 and older. In a study by Dündar et al. conducted in 2019, the average age of 10,692 patients presenting to the ED was 75.3 ± 7.3 years, with 50.8% of them being women (7). A meta-analysis by Moloney et al. in 2023 reported an average age of 79.8 years, with 52% of the patients being women (8). The age and sex distribution findings in our study are consistent with those of both national and international literature. In our study, 47.6% of the patients underwent hemogram tests, and 46.4% underwent biochemical testing. In a prospective study by Varisli et al. in 2018 involving 400 patients, hemogram tests were requested for 99% of patients and biochemical testing for 98% (9). In a retrospective cohort study by Celinski et al. involving 1,200 patients, 73.8% underwent blood tests (10). There was a 21.5% reduction in laboratory test requests after the establishment of the geriatric ED. In our study, 38.2% of patients requested imaging tests. Specifically, 18.7% of the patients underwent direct radiography, 18.6% underwent CT, and 8.1% underwent ultrasound imaging. In the study by Varisli et al., 75.2% of patients underwent direct radiography and 33.7% underwent CT scans (9). In a study by Celinski et al., 38.4% of patients underwent direct radiography and 23.4% underwent CT scans (10). There was a 25% reduction in the total number of imaging tests compared with that during the pre-geriatric ED era (p=0.00). We believe that the establishment of a separate examination area for geriatric patients and increased awareness among healthcare personnel have contributed to this reduction. In our study, 15.2% of the patients were referred to other specialties for consultation. This is lower compared to the rates reported by Varisli et al. (86.5%) (9). However, in our study, the number of consultations decreased by 47% compared with that during the pre-geriatric emergency period (p=0.00). We believe that the provision of care tailored to the physical needs of geriatric patients in separate examination and care areas will reduce the need for consultation. In our study, 6.6% of patients were admitted from the ED to the hospital. This is lower than the rates reported by Çelik et al. (42%), Varisli et al. (53.3%), and Koçak et al. (34%) (9-11-12). Liu et al.'s observational study in 2021 showed a significant decrease in hospitalization rates from 64.8% to 61.7% after the implementation of geriatric team and field practices (13). There was a 56% decrease in hospitalization rates compared with those before the establishment of the geriatric ED (p=0.00). This reduction can be attributed to the comprehensive geriatric assessments conducted by experienced and trained healthcare personnel. In our study, the waiting time from registration to examination was 7 min. This is significantly lower than the waiting times reported in a cohort study conducted in Switzerland, wherein the waiting time decreased from 144.2 min to 93.7 min after an intervention (14). There was a 65% reduction in waiting time compared with that before the establishment of the geriatric ED (p=0.00). According to our results, the average length of stay for older patients in the ED was 70 min. Sweeney et al. reported that factors, such as age, sex, number and continuity of tests and imaging, and triage category, significantly influenced the length of stay of geriatric patients in the ED. The reduction in unnecessary advanced diagnostic tests was aimed at establishing geriatric EDs. The training provided in our older individual-friendly ED project emphasized the importance of managing various aspects of care, such as atypical presentations and comorbidities, by physicians and nurses (15). The reduction in waiting times for patients triaged into categories four and five also played an important role in reducing hospital stay rates. The average length of stay in the ED decreased from 150 min to 70 min after the establishment of the geriatric ED (p=0.00). In a study conducted by Kanthala et al. using data from 270 hospitals, out of 5,400 patients aged 65 and older who presented to the ED, 104 (2%) had revisits within 72 h (16). Gettel et al., in a study involving 38 patients from geriatric emergency services and 152 from non- geriatric emergency services in 190 hospitals with data from 6,440,110 patients, found similar results of revisits within 72 h in both geriatric and non-geriatric emergencies (17). In our study, the rate of revisit, which was 4.5% before the establishment of the geriatric ED, was 3.7% in patients included in the study after opening the geriatric ED, and similar results were observed (p=0.27). The number of revisits in our study is consistent with that in the literature. Comprehensive and effective care for older patients leads to significant cost reduction (18). In a meta-analysis of 22 studies from six countries, Ellis et al. highlighted that comprehensive geriatric assessment would lead to a decrease in overall healthcare expenses (19). In a study by Varisli et al. in 2018, the average cost per patient was calculated to be $173.69 (9). In the study conducted at our hospital before the establishment of the geriatric ED, the average cost per patient was calculated to be $9.6 based on the average exchange rate of the period. After opening the geriatric ED, the average cost per patient was determined to be $5.9, or 133 TL. This increase in costs is attributed to inflation in our country. However, there was a significant difference in the costs per patient according to the exchange rates at the time of the study. The decrease in costs after the establishment of geriatric EDs is consistent with those in the literature and has also contributed positively to healthcare expenditures. The cost- effectiveness of geriatric emergency services was clearly demonstrated in this study. The results of the present study are highly positive. The geriatric ED was established with the support of the Erasmus+ project in terms of both scope and financing. Providing training to all personnel, including doctors, nurses, and the 112 emergency medical teams, transferring older patients to the ED, creating a separate area for geriatric emergency services, and redesigning the existing areas to meet the needs of older adults have led to an improvement in the quality of service and operation. Considering the increasing older adult population worldwide, widespread adoption of geriatric EDs will ensure the quality and effectiveness of geriatric emergency patient care LIMITATIONS Our study included patients categorized as 2–5 (Yellow-Green triage category according to the Ministry of Health), excluding unstable patients categorized as Triage category one (these patients were not included). The retrospective collection of data has led to partial data loss. Declarations All authors hereby declare that: The manuscript titled “ EVALUATION OF TURKEY'S FIRST GERIATRIC EMERGENCY DEPARTMENT AND QUALITY INDICATORS ” is an original work and has not been published or submitted elsewhere. All authors have made substantial contributions to the conception, design, data collection, analysis, and/or interpretation of the work. All authors have reviewed and approved the final version of the manuscript and agree with its submission to BMC Geriatrics There is no conflict of interest related to this study. No funding was received for this research. Ethical approval was obtained (if applicable), and all procedures were performed according to the Declaration of Helsinki. Informed consent was obtained from all participants (if applicable). The authors guarantee that all data and materials comply with field standards for reproducibility and transparency. Author Contributions (ICMJE Criteria) Author 1: Conceptualization, Study Design, Data Collection, Writing – Original Draft Author 2: Methodology, Formal Analysis, Data Interpretation Author 3: Literature Review, Visualization, Writing – Review & Editing Author 4: Supervision, Critical Revision of Manuscript Author 5: Data Collection, Validation, Resources Author 6: Project Administration, Final Approval of the Version to be Published All authors have read and approved the final version of this manuscript. Author Contribution Bora Baltacioglu¹, Mustafa Kesapli², Iffet Tiftikci³, Gizem Akcin⁴, Adeviyye Aksoy², Deniz Kilic²- **Author 1:** Conceptualization, Study Design, Data Collection, Writing – Original Draft- **Author 2:** Methodology, Formal Analysis, Data Interpretation- **Author 3:** Literature Review, Visualization, Writing – Review & Editing- **Author 4:** Supervision, Critical Revision of Manuscript- **Author 5:** Data Collection, Validation, Resources- **Author 6:** Project Administration, Final Approval of the Version to be Published References World Health Organization. Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity [e-book] 2017. [Internet] Available from: https://iris.who.int/bitstream/handle/10665/258981/9789241550109- eng.pdf?sequence = 1&isAllowed = y Accessed: 25.09.2017. United Nations. 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Trials. 2019;20(1):1–7. 10.1186/s13063-019-3697-5) . Schumacher JG, Hirshon JM, Magidson P, et al. Tracking the rise of geriatric emergency departments in the United States. J Appl Gerontol. 2020;39(8):871–9. 10.1177/0733464818813030) . Dundar ZD, Ayranci MK. Presenting symptoms of older emergency department patients: A single-center experience of 10,692 patients in Turkey. Acta Clin Belg. 2019;75(6):405–10. 10.1080/17843286.2019.1655215) . Moloney E, O’Donovan MR, Sezgin D, et al. Diagnostic accuracy of frailty screening instruments validated for use among older adults attending emergency departments: A systematic review and meta- analysis. Int J Environ Res Public Health. 2023;20(13):1–18. 10.3390/ijerph20136280) . Varisli B, Dogan FS, Yigitbaş MR. Clinical, demographic and cost evaluation of geriatric patients admitted to the emergency department. Anatol J Emerg Med. 2018;1(2):18–24. Celiński M, Cybulski M, Fiłon J, et al. 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Impact of a patient-flow physician coordinator on waiting times and length of stay in an emergency department: A before-after cohort study. PLoS ONE. 2018;13(12):e0209035. 10.1371/journal.pone.0209035) . Sweeny A, Keijzers G, O’Dwyer J, et al. Predictors of a long length of stay in the emergency department for older people. Intern Med J. 2019;50(5):572–81. 10.1111/imj.14441) . Kanthala AR, Allen BR, Lee JA, et al. 270 hospital outcomes in geriatric patients who had a 72-hour return visit to the emergency department. Ann Emerg Med. 2011;58(4):268. DOI:https://doi.org/10.1016/j.annemergmed.2011.06.300) . Gettel CJ, Hwang U, Janke AT, et al. An outcome comparison between geriatric and nongeriatric emergency departments. Ann Emerg Med. 2023;82(6):681–9. 10.1016/j.annemergmed.2023.05.013) . American College of Emergency Physicians; American Geriatrics Society, Emergency, Nurses, et al. Geriatric Emergency Department Guidelines. Ann Emerg Med. 2014;63(5):e7–25. 10.1016/j.annemergmed.2014.02.008) . Ellis G. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017; 12;9(9):CD006211. ( 10.1002/14651858.CD006211.pub3 ). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7848921","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549396058,"identity":"00129dc3-dbc9-4f06-bae6-fa2811a6326e","order_by":0,"name":"Bora 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Deniz","middleName":"","lastName":"Kilic²","suffix":""}],"badges":[],"createdAt":"2025-10-13 12:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7848921/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7848921/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96913876,"identity":"cb25b62f-2967-4e98-b9bf-4b09519b567a","added_by":"auto","created_at":"2025-11-27 14:04:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":865374,"visible":true,"origin":"","legend":"","description":"","filename":"SV20250512023.docx","url":"https://assets-eu.researchsquare.com/files/rs-7848921/v1/26d3e338b1847b6c20cc55e4.docx"},{"id":96746485,"identity":"142e3f71-48cb-4d58-82eb-af20b62085fd","added_by":"auto","created_at":"2025-11-25 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16:07:52","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84251,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7848921/v1/6a9931be9dda66a9c80881ae.html"},{"id":99314075,"identity":"09a4a534-5f00-4395-bd28-67c74a686dca","added_by":"auto","created_at":"2025-12-31 16:20:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":690289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7848921/v1/804e568b-29d8-4b6d-b1de-55692fb119f6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of Turkey's First Geriatric Emergency Department and Quality Indicators\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e\u003cstrong\u003eThe World Health Organization and United Nations define older individuals as those aged 65 and above\u003c/strong\u003e (1). According to United Nations reports, the proportion of the older population, which was 10% of the global population in 2022, is expected to increase to 16% by 2050 (2). Furthermore, the percentage of geriatric patients visiting emergency departments (EDs), currently between 15\u0026ndash;25%, is anticipated to reach 40% (3). Aging causes a decline in the functional capacity of the organ systems, increasing the risk of multiple diseases and complications (4). An increase in the older population and the number of individuals with multiple diseases has been identified as one of the primary reasons for the increase in ED visits. Research has shown that crowding in EDs leads to a decrease in service quality, delays in treatment initiation, prolonged hospital admissions or discharge times, increased overall costs, and incomplete implementation of clinical guidelines (5).\u003c/p\u003e\n\u003cp\u003eIn response to the growing older population and the subsequent need for quality emergency\u0026nbsp;healthcare\u0026nbsp;services,\u0026nbsp;the\u0026nbsp;first\u0026nbsp;\u0026quot;geriatric\u0026nbsp;ED\u0026quot; model\u0026nbsp;was\u0026nbsp;planned\u0026nbsp;in\u0026nbsp;2009 (6). To address the increasing need for and development of geriatric EDs, the American College of Emergency Physicians, Society for Academic Emergency Medicine, American Geriatrics Society, and Emergency Nurses Association came together in 2014 to define the quality standards and infrastructure for geriatric EDs, thereby initiating\u0026nbsp;the\u0026nbsp;accreditation\u0026nbsp;process.\u0026nbsp;This\u0026nbsp;collaboration\u0026nbsp;provides\u0026nbsp;guidance\u0026nbsp;for\u0026nbsp;the\u0026nbsp;high- quality care of older adults.\u003c/p\u003e\n\u003cp\u003eThis study aimed to evaluate the quality indicators of the first geriatric ED established in Turkey.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThe study was conducted retrospectively at the Emergency Medicine Clinic of Antalya Training and Research Hospital between June 1, 2023, and August 1, 2023. A total of 1,516 individuals aged 65 and above who met the study criteria and presented for non- traumatic reasons were included in the analysis. We have obtained all subjects\u0026rsquo; consent to participate. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical trial number: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Committee Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Clinical Research Ethics Committee of the University of Health Sciences (SBU) Antalya Training and Research Hospital, dated September 7, 2023, with approval number 12/22.. \u0026nbsp;As part of the Erasmus+ project \u0026quot;Safe and Friendly Medicine for Elderly (Safe and Friendly Emergency Department)\u0026quot; (2020-1-TR01-KA202-094358)-Strategic Partnerships for Vocational Education and Training, training was conducted for all physicians, auxiliary healthcare personnel working in the ED, as well as paramedics and healthcare personnel working in ambulances, during May and June 2022. This training, lasting 8 h in total, was provided to 285 healthcare personnel using the team-based learning method under the title \u0026quot;Management of Geriatric Emergency Medical Cases in Pre-Hospital and Emergency Department Settings\u0026quot; (covering topics such as communication with geriatric patients, atypical presentations, pain management, trauma, polypharmacy, abuse, ethics, and transition issues).\u003c/p\u003e\n\u003cp\u003eIn addition, a 2-h training session on communication with older patients was provided to all security, secretary, cleaning, and transport staff working in the ED. Thus, emergency healthcare service personnel working in the prehospital field and all healthcare personnel working in the ED were given awareness training regarding geriatric emergency patients, providing them with a unique perspective.\u003c/p\u003e\n\u003cp\u003eFollowing the training, physical arrangements and separate examination and observation areas were developed for patients categorized as triage levels 2\u0026ndash;5 according to a five-level triage scale. Patients aged over 65 years were evaluated in a separate examination area upon arrival at the ED, and those who required follow-up were transferred to a separate observation area. During these arrangements, the American College of Emergency Physicians\u0026rsquo; recommendations and standards were considered (such as noise measurement devices, sound isolation curtains, maximum daylight, comfortable patient beds, and additional visual and walking aids).\u003c/p\u003e\n\u003cp\u003eFollowing the physical and infrastructure changes, the examination, treatment, and follow-up of patients over 65 years of age who presented to the ED for non-traumatic reasons were provided in this area. Patients in triage category 1 and those with life-threatening instability were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe following information was collected simultaneously for each patient: age, sex, method of arrival, social living situation, waiting time for examination after registration (in minutes), ISAR score, diagnostic tests requested in the emergency department (ED), use of blood products, placement of a Foley catheter, application of physical restraints, assessment for abuse or neglect, diagnoses made in the ED, consultations requested, time taken to complete consultations, and the outcome of the ED visit.\u003c/p\u003e\n\u003cp\u003eIn addition to the final diagnosis, patient conditions were categorized into the following diagnostic groups: cardiovascular, neurological, respiratory, gastrointestinal, renal, infectious, genitourinary, oncological, hematological, and metabolic diseases. Cost-related data for each patient were recorded as the amounts billed to the Social Security Institution and documented in the Hospital Information Management System (HBYS) under medullary billing records.\u003c/p\u003e\n\u003cp\u003eData on hospital length of stay and 72-hour return rates were collected using the Ministry of Health\u0026apos;s e-Nabız system, the Death Information System, and the Hospital Information Management System (HBYS). The quality of care provided to geriatric patients was assessed according to national standards set by the Ministry of Health and relevant international guidelines. Evaluated quality indicators included emergency department (ED) readmissions, ED observation time, the response time of consulting physicians, and primary patient outcomes such as discharge from the ED, in-ED mortality, or admission to a hospital ward or intensive care unit.\u003c/p\u003e\n\u003cp\u003eData on patients aged over 65 years who presented to the ED for non-traumatic reasons before the establishment of the geriatric ED were collected from the hospital information system, focusing on similar demographic characteristics, and pre-geriatric ED quality criteria were recorded. After the geriatric ED became operational, the same quality criteria were evaluated again and compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using Statistical Package for the Social Sciences (version 23.0) and MedCalc (version 23.110). Numerical data are expressed as medians (interquartile ranges [\u003csup\u003e1\u003c/sup\u003eIQR]), and frequency data are expressed as percentages. For the comparison of two independent groups, the Mann\u0026ndash; Whitney U test was used for numerical data, whereas Pearson\u0026rsquo;s chi-square and Fisher\u0026rsquo;s exact tests were used for frequency data. Comparisons of three or more independent groups for frequency data were performed using the multiway chi-square test. If a statistically significant difference was found in the comparison of three or more groups using the multiway chi-square test, the Bonferroni chi-square residual analysis method was used in the post hoc analysis to identify the group responsible for the difference. Normality analysis was conducted using the Kolmogorov\u0026ndash;Smirnov test. Logistic regression analysis was used to identify independent variables that were effective in predicting hospital admission. All hypotheses were two-tailed, and the critical alpha value was set to 0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe study was conducted in the geriatric yellow and green areas of the ED at Antalya Training and Research Hospital. Between June 1, and August 1, 2023, a total of 1,516 individuals aged 65 and above who met the study criteria and presented for non- traumatic reasons were included in the analysis.\u003c/p\u003e\u003cp\u003eOf the patients, 703 (46.4%) were men and 813 (53.6%) were women, with an average age of 73 (range 65\u0026ndash;100) and an IQR of 68\u0026ndash;78. Most patients (92.5%, n\u0026thinsp;=\u0026thinsp;1,403) presented to the ED as outpatients. Among the patients included in this study, 88.3% (n\u0026thinsp;=\u0026thinsp;1,338) lived with their family, 11.1% (n\u0026thinsp;=\u0026thinsp;168) lived alone, and 0.7% (n\u0026thinsp;=\u0026thinsp;10) lived in nursing homes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge, Sex, Transfer Method and Social Status of Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, median (IQR)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e73 (68\u0026ndash;78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e703 (46.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e813 (53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTransfer Method\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutpatient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1403 (92.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmbulance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e113 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSocial Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eLiving with family Living alone\u003c/p\u003e\u003cp\u003eLiving in a nursing home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1338 (88.3)\u003c/p\u003e\u003cp\u003e168 (11.1)\u003c/p\u003e\u003cp\u003e10 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIQR, interquartile range.\u003c/p\u003e\u003cp\u003eThe most frequently requested tests were complete blood count (47.6%, n\u0026thinsp;=\u0026thinsp;721) and biochemistry (46.4%, n\u0026thinsp;=\u0026thinsp;703), followed by electrocardiography (31.9%, n\u0026thinsp;=\u0026thinsp;484). The most frequently requested samples were urine (1.3%, n\u0026thinsp;=\u0026thinsp;20) and blood (0.4%, n\u0026thinsp;=\u0026thinsp;6) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe most commonly requested imaging methods were plain radiography (18.7%, n\u0026thinsp;=\u0026thinsp;283) and non-contrast computed tomography (CT) (14.6%, n\u0026thinsp;=\u0026thinsp;221) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRequested Tests in Emergency Department\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eECG\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e484 (31.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemogram\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e721 (47.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBiochemistry\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e703 (46.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCardiac Panel\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e327 (21.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Blood Tests\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e380 (25.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBlood Product\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUltrasound\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 (8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComputed Tomography\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNot taken\u003c/p\u003e\u003cp\u003eNon-contrast CT Contrast CT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1234 (81.4)\u003c/p\u003e\u003cp\u003e221 (14.6)\u003c/p\u003e\u003cp\u003e61 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMagnetic Resonance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (2.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eX-Ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e283 (18.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eECG, electrocardiography; CT, computed tomography.\u003c/p\u003e\u003cp\u003eIn this study, 84.8% of patients (n\u0026thinsp;=\u0026thinsp;1,285) were discharged from the emergency department (ED) without requiring a consultation, while 15.2% (n\u0026thinsp;=\u0026thinsp;231) required at least one consultation. The median consultation duration in the ED was 88 minutes (interquartile range [IQR]: 52\u0026ndash;142 minutes).\u003c/p\u003e\u003cp\u003eAmong all patients, 93.4% (n\u0026thinsp;=\u0026thinsp;1,416) were discharged from the ED, 5.5% (n\u0026thinsp;=\u0026thinsp;83) were admitted to a hospital ward, and 1.1% (n\u0026thinsp;=\u0026thinsp;16) were transferred to the intensive care unit (ICU) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). One patient (0.1%) died in the ED. Of those discharged, 8.6% (n\u0026thinsp;=\u0026thinsp;131) returned to the ED within 72 hours. For admitted patients, the median hospital length of stay was 5 days (IQR: 3\u0026ndash;8) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe median waiting time for examination after registration was 7 minutes (IQR: 0\u0026ndash;21), and the median ED length of stay was 70 minutes (IQR: 5\u0026ndash;168). The median cost of ED care per patient was 5.9 US dollars (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Patient\u0026rsquo;s Ending Up, Readmission, Length of Stay and Cost datas\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndedupintheemergency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003edepartment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1416 (93.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmitted to service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (5.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmitted to ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (1.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReadmission in 72 h\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMedian (IQR)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaiting time for post-registration examination (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (0\u0026ndash;21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay in the emergency department (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (5\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospitalization (day)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency room cost (\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eICU, intensive care unit; IQR, interquartile range.\u003c/p\u003e\u003cp\u003eBefore the establishment of the geriatric ED, the number of requested tests was 1,087 (71.7%; p\u0026thinsp;=\u0026thinsp;0.00), whereas in our study, it was 761 (50.2%; p\u0026thinsp;=\u0026thinsp;0.00). The number of imaging procedures performed was 780 (51.5%; p\u0026thinsp;=\u0026thinsp;0.00) before and 580 (38.3%; p\u0026thinsp;=\u0026thinsp;0.00) after the establishment of the geriatric ED. There was a significant decrease in the number of consultations before the geriatric ED was established (16.1% vs. 6.6%; p\u0026thinsp;=\u0026thinsp;0.00). The waiting time after registration was 20 min (IQR: 7\u0026ndash;55) before and 7 min (IQR: 0\u0026ndash;21) after the establishment of the geriatric ED. The length of stay in the ED after the establishment of the geriatric ED also showed a significant decrease compared with that before the establishment of the geriatric ED (150 min vs. 70 min; p\u0026thinsp;=\u0026thinsp;0.00).\u003c/p\u003e\u003cp\u003eThe cost of care for patients presenting to the emergency department (ED) was calculated using the prevailing exchange rates during the respective study periods. A statistically significant difference was observed when comparing costs before and after the establishment of the geriatric ED. The median cost prior to the implementation was 9.6 USD (IQR: 2.6\u0026ndash;17.6; p\u0026thinsp;=\u0026thinsp;0.00), whereas the median cost after the establishment was 5.9 USD (IQR: 3.07\u0026ndash;12.53; p\u0026thinsp;=\u0026thinsp;0.00).\u003c/p\u003e\u003cp\u003eAlthough there was a reduction in the rate of return to the ED within 72 h, this decrease was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.27).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeriatric Emergency Department Before And After Comparison\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBeforethe\u003c/p\u003e\u003cp\u003eestablishment of the geriatric emergency department\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfterthe establishment of the geriatric emergency department\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDifference (%) (% 95 GA)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTests, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1087 (71.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e761 (50.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.5 (18\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImaging, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e780 (51.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e580 (38.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.2 (9.7\u0026ndash;16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsultation, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e439 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e231 (15.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.8 (10.9\u0026ndash;16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmitted to hospital, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.5 (7.3\u0026ndash;11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReadmission, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1 (2.4\u0026ndash;5.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaiting time for post- registration examination (min), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (7\u0026ndash;55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (0\u0026ndash;21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay in the emergency department (min), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150 (60\u0026ndash;295)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (5\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency room cost (\u003cspan\u003e$\u003c/span\u003e), median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e9.6 \u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003cp\u003e(25\u0026ndash;164)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.9 \u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003cp\u003e(80\u0026ndash;282)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIQR, interquartile range.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe average age of patients aged 65 and older who presented to our ED for non-traumatic reasons was found to be 73 ± 5 years, with women accounting for 53.6% of the cases. During the same period, it was determined that 14.3% of all patients who presented to the ED were aged 65 and older. In a study by Dündar et al. conducted in 2019, the average age of 10,692 patients presenting to the ED was 75.3 ± 7.3 years, with 50.8% of them being women (7). A meta-analysis by Moloney et al. in 2023 reported an average age of 79.8 years, with 52% of the patients being women (8). The age and sex distribution findings in our study are consistent with those of both national and international literature.\u003c/p\u003e\n\u003cp\u003eIn our study, 47.6% of the patients underwent hemogram tests, and 46.4% underwent biochemical\u0026nbsp;testing. In\u0026nbsp;a\u0026nbsp;prospective\u0026nbsp;study\u0026nbsp;by\u0026nbsp;Varisli\u0026nbsp;et\u0026nbsp;al. in\u0026nbsp;2018\u0026nbsp;involving\u0026nbsp;400\u0026nbsp;patients,\u003c/p\u003e\n\u003cp\u003ehemogram tests were requested for 99% of patients and biochemical testing for 98% (9). In a retrospective cohort study by Celinski et al. involving 1,200 patients, 73.8% underwent blood tests (10). There was a 21.5% reduction in laboratory test requests after the establishment of the geriatric ED.\u003c/p\u003e\n\u003cp\u003eIn our study, 38.2% of patients requested imaging tests. Specifically, 18.7% of the patients underwent direct radiography, 18.6% underwent CT, and 8.1% underwent ultrasound imaging. In the study by Varisli et al., 75.2% of patients underwent direct radiography and 33.7% underwent CT scans (9). In a study by Celinski et al., 38.4% of patients underwent direct radiography and 23.4% underwent CT scans (10). There was a 25% reduction in the total number of imaging tests compared with that during the pre-geriatric ED era (p=0.00). We believe that the establishment of a separate examination area for geriatric patients and increased awareness among healthcare personnel have contributed to this reduction.\u003c/p\u003e\n\u003cp\u003eIn our study, 15.2% of the patients were referred to other specialties for consultation. This is lower compared to the rates reported by Varisli et al. (86.5%) (9). However, in our study, the number of consultations decreased by 47% compared with that during the pre-geriatric emergency period (p=0.00). We believe that the provision of care tailored to the physical needs of geriatric patients in separate examination and care areas will reduce the need for consultation.\u003c/p\u003e\n\u003cp\u003eIn our study, 6.6% of patients were admitted from the ED to the hospital. This is lower than the rates reported by Çelik et al. (42%), Varisli et al. (53.3%), and Koçak et al. (34%) (9-11-12). Liu et al.'s observational study in 2021 showed a significant decrease in hospitalization rates from 64.8% to 61.7% after the implementation of geriatric team and field practices (13). There was a 56% decrease in hospitalization rates compared with those before the establishment of the geriatric ED (p=0.00). This reduction can be attributed to the comprehensive geriatric assessments conducted by experienced and trained healthcare personnel.\u003c/p\u003e\n\u003cp\u003eIn our study, the waiting time from registration to examination was 7 min. This is significantly lower than the waiting times reported in a cohort study conducted in Switzerland, wherein the waiting time decreased from 144.2 min to 93.7 min after an intervention (14). There was a 65% reduction in waiting time compared with that before the establishment of the geriatric ED (p=0.00).\u003c/p\u003e\n\u003cp\u003eAccording to our results, the average length of stay for older patients in the ED was 70 min. Sweeney et al. reported that factors, such as age, sex, number and continuity of tests and imaging, and triage category, significantly influenced the length of stay of geriatric patients in the ED. The reduction in unnecessary advanced diagnostic tests was aimed at establishing geriatric EDs. The training provided in our older individual-friendly ED project emphasized the importance of managing various aspects of care, such as atypical presentations and comorbidities, by physicians and nurses (15). The reduction in waiting times for patients triaged into categories four and five also played an important role in reducing hospital stay rates. The average length of stay in the ED decreased from 150 min to 70 min after the establishment of the geriatric ED (p=0.00).\u003c/p\u003e\n\u003cp\u003eIn a study conducted by Kanthala et al. using data from 270 hospitals, out of 5,400 patients aged 65 and older who presented to the ED, 104 (2%) had revisits within 72 h (16). Gettel et al., in a study involving 38 patients from geriatric emergency services and 152 from non- geriatric emergency services in 190 hospitals with data from 6,440,110 patients, found similar results of revisits within 72 h in both geriatric and non-geriatric emergencies (17). In our study, the rate of revisit, which was 4.5% before the establishment of the geriatric ED, was 3.7% in patients included in the study after opening the geriatric ED, and similar results were observed (p=0.27). The number of revisits in our study is consistent with that in the literature.\u003c/p\u003e\n\u003cp\u003eComprehensive and effective care for older patients leads to significant cost reduction (18). In a meta-analysis of 22 studies from six countries, Ellis et al. highlighted that comprehensive geriatric assessment would lead to a decrease in overall healthcare expenses (19). In a study by Varisli et al. in 2018, the average cost per patient was calculated to be $173.69 (9). In the study conducted at our hospital before the establishment of the geriatric ED, the average cost per patient was calculated to be $9.6 based on the average exchange rate of the period. After opening the geriatric ED, the average cost per patient was determined to be $5.9, or 133 TL. This increase in costs is attributed to inflation in our country. However, there was a significant difference in the costs per patient according to the exchange rates at the time of the study. The decrease in costs after the establishment of geriatric EDs is consistent with those in the literature and has also contributed positively to healthcare expenditures. The cost- effectiveness of geriatric emergency services was clearly demonstrated in this study.\u003c/p\u003e\n\u003cp\u003eThe results of the present study are highly positive. The geriatric ED was established with the support of the Erasmus+ project in terms of both scope and financing. Providing training to all personnel, including doctors, nurses, and the 112 emergency medical teams, transferring older patients to the ED, creating a separate area for geriatric emergency services, and redesigning the existing areas to meet the needs of older adults have led to an improvement in the quality of service and operation. Considering the increasing older adult population worldwide, widespread adoption of geriatric EDs will ensure the quality and effectiveness of geriatric emergency patient care\u0026nbsp;\u003c/p\u003e\n\u003ch1\u003e\u003c/h1\u003e\n\n"},{"header":"LIMITATIONS","content":"\u003cp\u003eOur study included patients categorized as 2–5 (Yellow-Green triage category according to the Ministry of Health), excluding unstable patients categorized as Triage category one (these patients were not included).\u003c/p\u003e\u003cp\u003eThe retrospective collection of data has led to partial data loss.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll authors hereby declare that:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe manuscript titled \u003cstrong\u003e\u0026ldquo;\u003c/strong\u003eEVALUATION\u0026nbsp;OF\u0026nbsp;TURKEY\u0026apos;S\u0026nbsp;FIRST\u0026nbsp;GERIATRIC\u0026nbsp;EMERGENCY\u0026nbsp;DEPARTMENT\u0026nbsp;AND\u0026nbsp;QUALITY\u0026nbsp;INDICATORS\u003cstrong\u003e\u0026rdquo;\u003c/strong\u003e is an original work and has not been published or submitted elsewhere.\u003c/li\u003e\n \u003cli\u003eAll authors have made substantial contributions to the conception, design, data collection, analysis, and/or interpretation of the work.\u003c/li\u003e\n \u003cli\u003eAll authors have reviewed and approved the final version of the manuscript and agree with its submission to BMC Geriatrics\u003c/li\u003e\n \u003cli\u003eThere is no conflict of interest related to this study.\u003c/li\u003e\n \u003cli\u003eNo funding was received for this research.\u003c/li\u003e\n \u003cli\u003eEthical approval was obtained (if applicable), and all procedures were performed according to the Declaration of Helsinki.\u003c/li\u003e\n \u003cli\u003eInformed consent was obtained from all participants (if applicable).\u003c/li\u003e\n \u003cli\u003eThe authors guarantee that all data and materials comply with field standards for reproducibility and transparency.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions (ICMJE Criteria)\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 1:\u003c/strong\u003e Conceptualization, Study Design, Data Collection, Writing \u0026ndash; Original Draft\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 2:\u003c/strong\u003e Methodology, Formal Analysis, Data Interpretation\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 3:\u003c/strong\u003e Literature Review, Visualization, Writing \u0026ndash; Review \u0026amp; Editing\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 4:\u003c/strong\u003e Supervision, Critical Revision of Manuscript\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 5:\u003c/strong\u003e Data Collection, Validation, Resources\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor 6:\u003c/strong\u003e Project Administration, Final Approval of the Version to be Published\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors have read and approved the final version of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBora Baltacioglu\u0026sup1;, Mustafa Kesapli\u0026sup2;, Iffet Tiftikci\u0026sup3;, Gizem Akcin⁴, Adeviyye Aksoy\u0026sup2;, Deniz Kilic\u0026sup2;- **Author 1:** Conceptualization, Study Design, Data Collection, Writing \u0026ndash; Original Draft- **Author 2:** Methodology, Formal Analysis, Data Interpretation- **Author 3:** Literature Review, Visualization, Writing \u0026ndash; Review \u0026amp; Editing- **Author 4:** Supervision, Critical Revision of Manuscript- **Author 5:** Data Collection, Validation, Resources- **Author 6:** Project Administration, Final Approval of the Version to be Published\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017; 12;9(9):CD006211. (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD006211.pub3\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD006211.pub3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"GERIATRIC EMERGENCY DEPARTMENT, QUALITY","lastPublishedDoi":"10.21203/rs.3.rs-7848921/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7848921/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e The global population of individuals aged 65 years and older is increasing, and the number of visits to emergency departments is rising accordingly. The establishment of geriatric emergency departments is recommended for managing medical emergencies in geriatric patients. This study aimed to evaluate the quality indicators of the first geriatric emergency department established in Turkey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Method: \u003c/strong\u003eThe quality criteria for patient care in the Geriatric Emergency Department at the Antalya Training and Research Hospital Emergency Department, established under the Erasmus + (2020-1-TR01-KA202- 094358) Strategic Partnerships for Vocational Education and Training project, were recorded and evaluated for both the pre- and post-establishment periods. Quality criteria determined by both international standards and the Ministry of Health were used for this comparison. For this purpose, during the period before the establishment of the service, from September 1 to November 1, 2021, 1,516 patients aged 65 and over who presented with non-traumatic reasons and were in triage categories 2–5 were compared with 1,516 geriatric patients in the same triage categories seen after the establishment of the geriatric emergency service between June 1 and August 1, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Following the establishment of the geriatric emergency department, statistically significant improvements were observed in the quality criteria related to the evaluation processes of patients aged 65 and older in the emergency department. In the pre- and post-establishment measurements of the quality criteria for triage categories 2–5, significant reductions were identified in waiting times for examinations (p=0.00), number of requested tests (p=0.00), number of requested imaging studies (p=0.00), number of necessary consultations (p=0.00), duration of stay in the emergency department (p=0.00), and cost per patient (p=0.00). The rate of readmission within 72 h was 3.7% (p=0.27).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The development and implementation of a geriatric emergency department model, applied for the first time in our country, have led to significant improvements in quality indicators that objectively evaluate service delivery. The establishment and expansion of geriatric emergency departments, specific to the growing population aged 65 years and older, should be supported and promoted both in our country and worldwide.\u003c/p\u003e","manuscriptTitle":"Evaluation of Turkey's First Geriatric Emergency Department and Quality Indicators","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 16:07:47","doi":"10.21203/rs.3.rs-7848921/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"014dbbd4-6279-4876-bd72-eb57bf4620ce","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-26T11:39:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 16:07:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7848921","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7848921","identity":"rs-7848921","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}