急诊科观察单元是符合老年急诊科指南的多学科老年评估的可行设置。
An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines.
机构信息
Department of Emergency Medicine, The Ohio State University, Columbus, OH.
The Ohio State University School of Medicine, Columbus, OH.
出版信息
Acad Emerg Med. 2018 Jan;25(1):76-82. doi: 10.1111/acem.13328. Epub 2017 Nov 24.
BACKGROUND
The Geriatric Emergency Department (ED) Guidelines recommend providing multidisciplinary geriatric assessment in the ED, but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED observation unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit.
METHODS
Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients. Use of any or all of these ancillary consult services could be requested by the Obs Unit physician. A retrospective chart review of random older adult Obs Unit patients was done to assess rates of consult use and interventions by these consulting teams. All patients ≥ 65 years old in our institutional review board-approved, monthly Obs Unit quality database from October 2015 through March 2017 were included.
RESULTS
Our quality database included 221 older patients over 18 months. The mean (±SD) age was 73.3 (±6.8) years (range = 65-96 years) and 55.2% were women. The mean (±SD) observation length of stay was 14.7 (±6.5) hours. The majority (74.3%) were discharged from the Obs Unit and 72-hour ED recidivism was 3.6%. Overall, at least one of the multidisciplinary consultant services were requested in 40.3% of patients (n = 89). Additional interventions or services were recommended in 80.0% of patients evaluated by physical therapy (32 of 40 patients), 100% of those evaluated by a pharmacist (five of five patients), 38% of those evaluated by case management (27 of 71 patients), and 100% of those evaluated by a geriatrician (eight of eight patients). Only 5.4% (n = 12) of patients were placed in observation specifically for multidisciplinary assessment; these patients had a mean (±SD) length of stay of 12.2 (±5) hours and an admission rate of 41.7%.
CONCLUSIONS
Incorporating elements of multidisciplinary geriatric assessment for older patients is feasible within an observation time frame and resulted in targeted interventions. An Obs Unit is a reasonable setting to offer services in compliance with the Geriatric ED Guidelines.
背景
老年急诊科（ED）指南建议在 ED 提供多学科老年评估，但这些评估可能难以协调，并且可能会延长住院时间。需要超过典型 ED 停留时间的患者可以安置在 ED 观察单元（Obs Unit）。我们研究了在 Obs Unit 为 ED 患者提供多学科评估的效果。
方法
为所有 Obs Unit 患者提供老年医院咨询小组、物理治疗师、病例经理和/或药剂师的评估。Obs Unit 医生可以要求使用这些辅助咨询服务中的任何一项或全部。对随机的老年 Obs Unit 患者进行回顾性图表审查，以评估咨询团队的使用情况和干预措施。从 2015 年 10 月至 2017 年 3 月，我们机构审查委员会批准的每月 Obs Unit 质量数据库中包括所有年龄在 65 岁及以上的患者。
结果
我们的质量数据库包括 18 个月内的 221 名老年患者。平均（±SD）年龄为 73.3（±6.8）岁（范围为 65-96 岁），55.2%为女性。观察停留时间的平均（±SD）为 14.7（±6.5）小时。大多数（74.3%）从 Obs Unit 出院，72 小时 ED 再入院率为 3.6%。总体而言，在 40.3%的患者（n=89）中至少有一项多学科顾问服务被要求。在接受物理治疗评估的 32 名患者（40 名患者中的 80.0%）、接受药剂师评估的 5 名患者（5 名患者中的 100%）、接受病例管理评估的 27 名患者（71 名患者中的 38%）和接受老年科医生评估的 8 名患者（8 名患者中的 100%）中，建议进行额外的干预或服务。只有 5.4%（n=12）的患者因多学科评估而专门观察，这些患者的平均（±SD）停留时间为 12.2（±5）小时，入院率为 41.7%。
结论
在观察时间框架内纳入老年患者多学科评估的要素是可行的，并产生了针对性的干预措施。Obs Unit 是一个符合老年 ED 指南提供服务的合理场所。
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