Stuck Amy R, Crowley Christopher, Killeen James, Castillo Edward M
Successful Aging, West Health Institute, La Jolla, California.
Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California.
J Emerg Med. 2017 Nov;53(5):623-628.e2. doi: 10.1016/j.jemermed.2017.05.036. Epub 2017 Sep 20.
Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium.
The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care.
A group of 1200 EPs nationwide were e-mailed a six-question survey.
Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia.
Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption.
在美国，急诊科在医院收治患者方面发挥着重要作用，尤其是对于日益增多的老年人群体。居家护理，而非从急诊科收治入院，提供了一种重要的替代方案，特别是对于那些发生不良事件风险更高的老年人，如医院获得性感染、跌倒和谵妄。
该调查的目的是了解急诊医生对于急诊科居家护理替代住院治疗的看法。具体目标包括确定急诊医生开具居家护理医嘱的频率、他们认为更广泛开具居家护理医嘱的障碍和动机，以及最适合此类护理的具体病情和响应时间。
向全国1200名急诊医生发送了一份包含六个问题的调查问卷。
参与者的回复率为57%。其中，55%报告在过去一年中从急诊科开具居家护理医嘱作为住院或观察的替代方案，大多数人每月开具次数少于一次。最常见的障碍是“家庭环境不安全或不稳定”（73%）。将居家护理视为“护理低 acuity 慢性或急性疾病加重的更好环境”是首要动机（79%）。急诊医生最常考虑采用居家护理的医疗状况是蜂窝织炎、尿路感染、糖尿病和社区获得性肺炎。
结果表明，急诊医生认识到提供居家护理作为住院替代方案有好处，前提是他们认为家庭环境安全且有将患者安置到这种环境的流程。更好地了解急诊医生何时以及为何使用急诊科的居家护理途径可能会为促进更广泛采用的方法提供建议。
