Ibrahim Kinda, Owen Charlotte, Patel Harnish P, May Carl, Baxter Mark, Sayer Avan A, Roberts Helen C
Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Mailpoint 807, Southampton, SO16 6YD, UK.
NIHR CLAHRC Wessex, Faculty of Health Science, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
BMC Res Notes. 2017 Aug 10;10(1):384. doi: 10.1186/s13104-017-2705-7.
Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital.
Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes.
对于有医疗保健不良结局风险的老年患者，应在入院早期予以识别，以便采取适当干预措施。目前尚不清楚常规收集的数据能否识别高危患者。本研究的目的是确定在医院入院时识别有医疗保健不良结局高风险老年患者的当前做法。
我们进行了访谈/焦点小组讨论，以了解一家医院五个老年急性内科病房的22名医护人员的观点，其中包括7名护士、4名营养师、7名医生和4名治疗师。此外，随机抽取了60份患者临床记录进行审查，以描述老年患者的特征，确定入院时常规进行的风险评估，并描述常规护理情况。我们发现，工作人员依靠临床判断来识别高危患者，这受到多种因素的影响，如入院原因、工作人员对患者的熟悉程度、患者的一般状况、明显的虚弱程度以及患者在家中的自理能力。“治疗评估”以及患者参与治疗在识别高危患者方面也被认为很重要。然而，工作人员认识到做出临床判断往往很困难，而且可能在入院几天后才做出，这可能会延迟具体干预措施。入院时进行的常规风险评估以确定单一医疗需求，包括营养不良风险评估（85%的患者完成）、跌倒风险评估（95%）、搬运评估（85%）和压疮风险评估（88%）。这些评估并未综合用于突出有医疗保健不良结局风险的患者。因此，在入院时并未使用常规收集的数据明确识别有医疗保健不良结局风险的患者。需要使用有效的测量方法并结合工作人员的临床判断尽早识别这些患者，以便及时进行干预，改善医疗保健结局。
