Research Unit of Nursing, Institute of Clinical Research, University of Southern Denmark, Odense and Copenhagen University Hospital, Amager, Denmark.
Int J Older People Nurs. 2012 Jun;7(2):141-51. doi: 10.1111/j.1748-3743.2012.00323.x. Epub 2012 Apr 12.
To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department (ED).
Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home from an ED as time pressure requires staff to focus on the presenting problem although many have complex, unresolved, care needs.
A prospective descriptive pilot study was conducted. Older people aged 70 and over and at risk of adverse health and functional outcome were included.
At discharge, and at 1 and 6 months follow-up, a brief standardised nursing assessment (ISAR 2) developed by McCusker et al. was carried out. The focus was on unresolved problems that required medical or nursing intervention, new or different home care services or comprehensive geriatric assessment. After assessment, the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next of kin.
One hundred and fifty people participated, mean age was 81.7. At discharge, they had a mean of 1.9 unresolved problems, after 1 month 0.8, and after 6 months 0.4. Older people receiving home care services increased from 79% at discharge to 89% at 1 month and 90% at 6 months follow-up.
ISAR 2 works well in a Danish ED setting and intercepts older peoples' problems. It seems that unresolved problems decrease when a nurse assesses and intervenes at discharge from ED, and at follow-up. However, a randomised controlled test should be carried out to confirm this.
Nursing assessment and intervention should be implemented in the ED to reduce older peoples' unrevealed problems.
描述并测试一种针对从急诊科（ED）出院的老年人进行结构化护理评估和干预的模型。
最近从医院出院的老年人再次入院的风险很高。当他们直接从 ED 出院回家时，由于时间压力，工作人员必须专注于当前的问题，尽管许多人有复杂的、未解决的护理需求，这种风险可能会增加。
进行了一项前瞻性描述性试点研究。纳入年龄在 70 岁及以上且有不良健康和功能结果风险的老年人。
在出院时以及 1 个月和 6 个月的随访时，对 McCusker 等人开发的简短标准化护理评估（ISAR 2）进行评估。重点是需要医疗或护理干预、新的或不同的家庭护理服务或全面老年评估的未解决问题。评估后，护士将相关转介到老年门诊、社区卫生中心、全科医生或与家属安排。
150 人参与，平均年龄为 81.7 岁。出院时，他们有 1.9 个未解决的问题，1 个月后为 0.8 个，6 个月后为 0.4 个。接受家庭护理服务的老年人出院时为 79%，1 个月时增加到 89%，6 个月时增加到 90%。
ISAR 2 在丹麦 ED 环境中运行良好，可以发现老年人的问题。似乎当护士在 ED 出院时和随访时评估和干预时，未解决的问题会减少。但是，应该进行随机对照试验来证实这一点。
应该在 ED 中实施护理评估和干预，以减少老年人未被发现的问题。
