Department of Clinical service, St, Olavs University Hospital, Olav Kyrres gt.17, Trondheim, Norway.
BMC Health Serv Res. 2010 Jan 4;10:1. doi: 10.1186/1472-6963-10-1.
Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents.The aim of the present study was to describe unwanted incidents registered by the AT among patients discharged from a geriatric evaluation and management unit (GEMU) by character, frequency and stage in the transitional process. Only unwanted incidents with a severity making contact with the primary health care (PHC) necessary were registered.
A prospective observational study with patients treated in the GEMU and followed by the AT was performed. Current practice included comprehensive geriatric assessment and management including discharge planning in the GEMU and collaboration with the primary health care on appointments on assistance to be provided after discharge from hospital. Unwanted incidents severe enough to induce contact with the primary health care were registered during the transitional phase and after discharge.
118 patients (65% female), with mean age 83.2 +/- 6.4 years participated. Median Barthel Index at discharge was 18 (interquartile range 16-19) and median Mini Mental Status Examination 24 (interquartile range 21-26). A total of 146 unwanted incidents were registered in 70 (59%) of the patients. Most frequent were unwanted incidents related to drug prescription regime (32%), exchange of information in and between the GEMU and the primary health care (25%) and service or help provided from the PHC (17%).
Despite a seemingly well-organised system for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients.
最近从医院出院的老年患者再次住院和入住养老院的几率增加。多项研究表明，药物相关差异很常见。但很少有研究报告除药物以外的其他因素导致的不良事件。2002 年，挪威特隆赫姆圣奥拉夫大学医院 HF 老年科成立了一个门诊团队（AT）。该团队负责监测患者从医院到家庭的过渡情况，以及出院后四周的情况，以发现不良事件。本研究的目的是描述 AT 在老年评估和管理病房（GEMU）出院的患者中发现的不良事件的特征、频率和过渡阶段。仅记录严重程度需要与初级保健（PHC）联系的不良事件。
对在 GEMU 接受治疗并由 AT 随访的患者进行前瞻性观察研究。目前的做法包括全面的老年评估和管理，包括在 GEMU 中进行出院计划，并与初级保健合作，安排在医院出院后提供的帮助。在过渡阶段和出院后，记录严重程度足以引起与初级保健联系的不良事件。
118 名患者（65%为女性），平均年龄 83.2+/-6.4 岁。出院时平均巴氏指数为 18（四分位距 16-19），简易精神状态检查平均 24（四分位距 21-26）。70 名（59%）患者共记录 146 起不良事件。最常见的是与药物处方方案相关的不良事件（32%）、GEMU 内和 GEMU 与 PHC 之间的信息交换（25%）以及 PHC 提供的服务或帮助（17%）。
尽管患者从 GEMU 到家庭的过渡系统看似组织良好，但在大多数患者出院或出院后四周内，都会发生一起或多起不良事件。该研究揭示了改善老年患者过渡护理的重要领域。
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