Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, WA 6000, Australia.
Emerg Med Australas. 2013 Apr;25(2):127-31. doi: 10.1111/1742-6723.12049. Epub 2013 Feb 19.
There is increasing focus on use of multidisciplinary services within the ED to facilitate discharge of older patients that might otherwise require hospitalisation. The risks associated with this are not well established. We aimed to determine whether older patients requiring allied health-facilitated discharge from the ED were at increased risk of hospital readmission and death after discharge.
A prospective comparative study with matched controls. Patients aged 65 years and over presenting to the ED underwent risk screening. Those with a positive screen formed the intervention group and received comprehensive allied health input from a care coordination team (CCT) prior to discharge. We prospectively enrolled 1098 patients to the intervention group and matched these 1:1 with controls deemed low risk on risk screening. The primary outcome measure was ED re-attendance within 28 days. Patients were followed up for a minimum of 1 year for other outcomes.
At 28 days, there was a 3% absolute difference in the re-attendance rate to ED (17.9% cases, 14.8% controls, P = 0.05) and no mortality difference (1.4% cases, 1.3% controls, P = 0.85). At 1 year, cases had a higher incidence of unplanned hospitalisation (43.4% vs 29.5%, P < 0.001) but not death (10.7% vs 10.2%, P = 0.66).
Facilitated discharge of selected older adults by a CCT is relatively safe in the short term. Such patients have an increased likelihood of hospitalisation in the year after discharge. The 1 year mortality rate even in a 'low-risk' discharged population is 10%.
越来越关注在急诊室使用多学科服务，以促进可能需要住院的老年患者出院。但这种做法的相关风险尚未得到很好的确定。我们旨在确定是否需要由辅助健康人员协助从急诊室出院的老年患者在出院后再次住院和死亡的风险增加。
这是一项前瞻性对照研究，设置了匹配对照。对年龄在 65 岁及以上的急诊科就诊患者进行风险筛查。阳性筛查患者构成干预组，在出院前接受来自护理协调小组（CCT）的综合辅助健康干预。我们前瞻性地将 1098 名患者纳入干预组，并与在风险筛查中被认为低风险的对照组进行 1:1 匹配。主要结局指标为 28 天内急诊科再次就诊。对患者进行至少 1 年的随访，以观察其他结局。
在 28 天内，急诊科再次就诊的绝对差异率为 3%（17.9%的病例，14.8%的对照组，P = 0.05），死亡率无差异（1.4%的病例，1.3%的对照组，P = 0.85）。在 1 年内，病例组的非计划性住院率更高（43.4%比 29.5%，P < 0.001），但死亡率无差异（10.7%比 10.2%，P = 0.66）。
CCT 协助选择的老年患者出院在短期内相对安全。这类患者在出院后 1 年内更有可能再次住院。即使在“低风险”出院人群中，1 年死亡率也高达 10%。
