Poncia H D, Ryan J, Carver M
Department of Accident and Emergency Medicine, Royal Sussex County Hospital, Brighton.
J Accid Emerg Med. 2000 Sep;17(5):337-40. doi: 10.1136/emj.17.5.337.
Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department.
The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents.
The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year.
Patients aged 75 years or over who were discharged from the A&E department.
Nursing home patients. Patients without a telephone.
Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required.
551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment.
Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.
75岁以上的患者在急诊（A&E）科室就诊人数中所占比例日益增加。在这一群体中，合并症的发生率很高，这就要求从急诊科进行有效的出院协调。
本研究的目的是评估这些患者出院后第二天的需求，针对合适的干预措施确定目标患者，并识别关键事件。
该研究在一家区级综合医院的急诊科进行，该科室每年有62000名新患者就诊。
从急诊科出院的75岁及以上患者。
养老院患者。没有电话的患者。
从病历中收集出院前信息。然后，社区联络护士（CLN）通过电话联系患者。使用半结构化问卷对患者进行评估。对患者进行风险分层并采取适当的干预措施。CLN发起的干预措施根据所需的投入水平从1到6进行评分。
通过电话联系了551名患者或其护理人员。44例（8%）患者认为现有的家庭支持不足，另有45例（8%）患者需要立即干预。65例（11%）1类患者无需干预，223例（42%）2类患者仅需建议，107例（19%）3类患者被转诊至其全科医生处，127例（23%）4类患者需要全科医生或护士进行家访，26例（5%）5类患者有风险需要紧急家庭评估，3例6类患者不得不再次前往急诊科就诊。CLN就广泛的问题提供了建议，并联系了广泛的医疗保健服务。CLN在电话评估后进行了559次转诊。
对我院急诊科75岁以上患者进行电话随访，发现了出院前后一些可以改进护理的领域。这种低成本、高质量的干预措施有可能减少弱势群体对该科室的不当复诊次数，并提高整体护理质量。
