Emergency Medicine, Centre for Clinical Research in Emergency Medicine, Western Australian Centre for Medical Research, Royal Perth Hospital, University of Western Australia.
Age Ageing. 2010 May;39(3):306-12. doi: 10.1093/ageing/afq008. Epub 2010 Feb 22.
emergency care for older people living in residential aged care facilities (RACF) is a complex area of health policy. The epidemiology of patient transfer between RACF and hospital emergency departments (ED), clinical outcomes and costs associated with transfer and efficacy of programs aiming to reduce transfer are not well known.
systematic review based on a comprehensive literature search in three electronic databases and published article reference lists.
the incidence of transfer from RACF to ED is >30 transfers/100 RACF beds/year in most studies. The casemix from RACF is varied and reflects that of the broad elderly population, with some risk difference. At least 40% of transfers are not admitted to hospital. There is insufficient data to fully address our other questions; however, hospitalisations from RACF can be reduced through advanced care planning, use of management guidelines for acute illnesses and improved primary care.
residents of RACF have a high annual risk of transfer to ED. The clinical benefit and cost effectiveness of ED care, and alternate programs to reduce ED transfer, cannot be confidently compared from published work. Further research is required to accurately describe these and to determine their comparative worth.
老年人居住的养老院（RACF）的紧急护理是一个复杂的卫生政策领域。RACF 与医院急诊科（ED）之间的患者转移的流行病学、与转移相关的临床结果和成本以及旨在减少转移的计划的疗效尚不清楚。
基于三个电子数据库和已发表文章参考文献列表的全面文献检索进行的系统评价。
在大多数研究中，从 RACF 到 ED 的转移发生率>30 次/每 100 张 RACF 床位/年。RACF 的病例组合各不相同，反映了广泛的老年人群，存在一定的风险差异。至少有 40%的转移没有住院。没有足够的数据来充分解决我们的其他问题；然而，可以通过预先护理计划、急性疾病管理指南的使用和改善初级保健来减少从 RACF 的住院治疗。
RACF 的居民每年有很高的风险转移到 ED。从已发表的工作中，无法有信心地比较 ED 护理的临床效益和成本效益，以及减少 ED 转移的替代方案。需要进一步的研究来准确描述这些方案，并确定它们的相对价值。
