Carron Pierre-Nicolas, Mabire Cédric, Yersin Bertrand, Büla Christophe
Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
University of Health Sciences (HESAV), Lausanne, Switzerland.
Intern Emerg Med. 2017 Mar;12(2):229-237. doi: 10.1007/s11739-016-1459-x. Epub 2016 May 13.
The increasing number of elderly persons produces an increase in emergency department (ED) visits by these patients, including nursing home (NH) residents. This trend implies a major challenge for the ED. This study sought to investigate ED visits by NH residents in an academic hospital. A retrospective monocentric analysis of all ED visits by NH residents between 2005 and 2010 in a Swiss urban academic hospital. All NH residents aged 65 years and over were included. Socio-demographic data, mode of transfer to ED, triage severity rating, main reason for visit, ED and hospital length of stay, discharge dispositions, readmission at 30 and 90 day were collected. Annual ED visits by NH residents increased by 50 % (from 465 to 698) over the study period, accounting for 1.5 to 1.9 % of all ED visits from 2005 to 2010, respectively. Over the period, yearly rates of ED visits increased steadily from 18.8 to 27.5 per 100 NH residents. Main reasons for ED visits were trauma, respiratory, cardiovascular, digestive, and neurological problems. 52 % were for urgent situations. Less than 2 % of NH residents died during their ED stay and 60 % were admitted to hospital wards. ED use by NH residents disproportionately increased over the period, likely reflecting changes in residents and caregivers' expectations, NH staff care delivery, as well as possible correction of prior ED underuse. These results highlight the need to improve ED process of care for these patients and to identify interventions to prevent potentially unnecessary ED transfers.
老年人数量的增加导致包括养老院居民在内的这类患者到急诊科就诊的人数增多。这一趋势给急诊科带来了重大挑战。本研究旨在调查一所学术医院中养老院居民的急诊科就诊情况。对瑞士一家城市学术医院2005年至2010年间养老院居民的所有急诊科就诊情况进行回顾性单中心分析。纳入所有年龄在65岁及以上的养老院居民。收集社会人口统计学数据、转至急诊科的方式、分诊严重程度评级、主要就诊原因、急诊科和住院时间、出院处置情况、30天和90天的再入院情况。在研究期间，养老院居民的年度急诊科就诊人数增加了50%（从465人次增至698人次），分别占2005年至2010年所有急诊科就诊人数的1.5%至1.9%。在此期间，每年每100名养老院居民的急诊科就诊率从18.8稳步增至27.5。急诊科就诊的主要原因是创伤、呼吸、心血管、消化和神经问题。52%是紧急情况。不到2%的养老院居民在急诊科停留期间死亡，60%被收治入院。在此期间，养老院居民的急诊科使用率不成比例地增加，这可能反映了居民和护理人员期望的变化、养老院工作人员的护理服务，以及可能对之前急诊科使用不足的纠正。这些结果凸显了改善这类患者急诊科护理流程以及确定预防潜在不必要的急诊科转诊干预措施的必要性。
