Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia.
Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Alfred Hospital 99 Commercial Road Melbourne, VIC, Melbourne, Victoria 3004, Australia Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Age Ageing. 2014 Nov;43(6):759-66. doi: 10.1093/ageing/afu117. Epub 2014 Oct 14.
residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital.
a comprehensive search of the peer-reviewed literature using four electronic databases. Inclusion criteria were participants lived in nursing homes, care homes or long-term care, aged at least 65 years, and studies reported outcomes of acute ED transfer or hospital admission. Findings were synthesized and key factors identified.
residents of RACF frequently presented severely unwell with multi-system disease. In-hospital complications included pressure ulcers and delirium, in 19 and 38% of residents, respectively; and up to 80% experienced potentially invasive interventions. Despite specialist emergency care, mortality was high with up to 34% dying in hospital. Furthermore, there was extensive use of healthcare resources with large proportions of residents undergoing emergency ambulance transport (up to 95%), and inpatient admission (up to 81%).
acute emergency department (ED) transfer is a considerable burden for residents of RACF. From available evidence, it is not clear if benefits of in-hospital emergency care outweigh potential adverse complications of transfer. Future research is needed to better understand patient-centred outcomes of transfer and to explore alternative models of emergency healthcare.
养老院居民人数不断增加。居民往往身体虚弱，合并症较多，功能和认知障碍严重，容易突发疾病。尽管居住在有卫生专业人员配备的设施中，仍有相当一部分居民因健康状况急剧恶化而转往医院接受治疗。这种紧急护理模式可能会给患者和医疗系统带来意想不到的后果。本综述描述了从养老院转至医院的后果的现有证据。
使用四个电子数据库对同行评议文献进行全面检索。纳入标准为：参与者居住在养老院、护理院或长期护理机构中，年龄至少 65 岁，且研究报告了急性急诊科转院或住院的结果。综合研究结果并确定关键因素。
养老院居民常因多系统疾病而病情严重。院内并发症包括压疮和谵妄，分别在 19%和 38%的居民中发生；多达 80%的居民经历了潜在的侵入性干预。尽管接受了专科紧急护理，死亡率仍很高，高达 34%的居民在医院死亡。此外，还广泛使用了医疗保健资源，高达 95%的居民接受了紧急救护车转运，高达 81%的居民接受了住院治疗。
急性急诊科转院对养老院居民来说是一个相当大的负担。根据现有证据，尚不清楚医院急诊护理的益处是否超过转院潜在的不良并发症。需要进一步研究以更好地了解转院的以患者为中心的结果，并探索急诊医疗保健的替代模式。
