Centre of Research Excellence in Patient Safety, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2013 Jan;43(1):59-65. doi: 10.1111/j.1445-5994.2012.02842.x.
BACKGROUND/AIMS: To examine non-clinical factors associated with emergency department (ED) attendance by lower urgency older patients.
An exploratory descriptive study comprising structured interviews with lower urgency community-dwelling patients aged ≥70 years presenting to a tertiary metropolitan Melbourne public hospital ED. Demographical and clinical characteristics, self-reported feelings of social connectedness, perceived accessibility to primary care, reason for attending ED were measured.
One hundred patients were interviewed: mean age 82 years, 56% female, 57% lived alone; 73% presented during business hours, 58% arrived by ambulance, 80% presented for illness, and 65% were discharged home within 48 h. Fifty-six per cent of patients reported feeling socially disconnected, comprising 49% living alone compared with 65% who lived with their spouse/family. All patients attended a regular general practitioner, 31% reporting regular review appointments. Thirty-five per cent reported waiting times >2-3 days for urgent problems; 59% stated accessing care 'after hours' without attending ED as difficult, with 20% having attended ED 3-6 times in the previous 12 months. Reasons for attending ED were referral by a third party, difficulty with accessibility to primary care, patient preferences for timely care and fast-track access to specialist care.
Most older patients of lower clinical urgency presented to ED because of perceived access block to primary or specialist services, alongside an expectation of more timely and specialised care. This suggests that EDs should be redesigned and/or integrated community-based models of care developed to meet the specific needs of this age group who have growing demand for acute care.
背景/目的：研究与低紧急度老年患者到急诊科（ED）就诊相关的非临床因素。
一项探索性描述性研究，对 100 名居住在社区且年龄≥70 岁、到墨尔本一家三级大都市公立医院 ED 就诊的低紧急度患者进行了结构访谈。测量了人口统计学和临床特征、自我报告的社交联系感、感知到的初级保健可及性、到 ED 就诊的原因。
共对 100 名患者进行了访谈：平均年龄 82 岁，56%为女性，57%独居；73%在营业时间就诊，58%乘坐救护车到达，80%因疾病就诊，65%在 48 小时内出院回家。56%的患者报告感到社交脱节，包括 49%独居，而 65%与配偶/家人一起生活。所有患者都定期看全科医生，其中 31%报告定期复诊。35%的患者报告等待时间超过 2-3 天，对紧急问题的等待时间>2-3 天；59%表示在下班后寻求医疗服务困难，其中 20%在过去 12 个月内去过 ED 3-6 次。到 ED 就诊的原因是第三方转诊、难以获得初级保健、患者希望获得及时的护理和快速获得专科护理。
大多数低临床紧急度的老年患者到 ED 就诊是因为认为初级或专科服务存在获取障碍，同时期望获得更及时和专业的护理。这表明，应该重新设计 ED，并/或开发基于社区的综合护理模式，以满足对急性护理需求不断增长的这一年龄组的特定需求。
