Berben Sivera A A, Bloemhoff Anneke, Habets Karin C F, Liefers Janine, Hensens Chantal J M, van Grunsven Pierre M, Schoon Yvonne, van den Berg H A M
Acute Zorgregio Oost, Nijmegen.
Contact: A. Bloemhoff (
Ned Tijdschr Geneeskd. 2019 Jul 29;163:D3523.
To gain insight into the differences in emergency care offered to elderly (65+ years) and younger patients (20-64 years). The emergency care pathway includes: out-of-hours general practitioner cooperatives, regional ambulance services, psychiatric emergency medical services, accident and emergency departments and acute cardiac care units.
Retrospective cohort study.
We used data from all emergency care contacts from the Emergency Care Monitor of April 2015 and April 2016 from an emergency care region in the east of the Netherlands ('Acute Zorgregio Oost'); this involved 84,647 care contacts with 55,061 patients. We defined pathway emergency care contacts as multiple emergency care contacts with different healthcare providers within the emergency care pathway, and differentiated between single or repeated care contacts with a single emergency healthcare provider. We investigated differences in presenting symptoms, diagnoses, lead time, hospital admissions and mortality in the chain care.
Emergency care contact was more often pathway contact in elderly than in younger patients (26% vs. 16%; p < 0.0001). Elderly patients more often received a diagnosis of CVA, pneumonia or exacerbation of COPD, while younger patients more often had simple contusions or abdominal symptoms. Pathway lead time was longer in elderly than in younger patients (median difference: 33 minutes; 95% CI: 25-40. Elderly patients were admitted to hospital more often (71% vs. 39%, p < 0.0001) and their mortality rate was higher (2.0% vs. 0.5%; p < 0.0001).
Elderly patients in the emergency care pathway have more frequent and longer pathway contact and present themselves with a more complicated and life-threatening clinical picture than younger patients. New solutions should be explored to ensure that the emergency care pathway remains accessible and available and offers sufficient quality for the increasing number of elderly.
深入了解为老年患者（65岁及以上）和年轻患者（20 - 64岁）提供的急诊护理差异。急诊护理途径包括：非工作时间全科医生合作社、区域救护车服务、精神科急诊医疗服务、急诊科和急性心脏护理单元。
回顾性队列研究。
我们使用了来自荷兰东部一个急诊护理区域（“急性护理区域东部”）2015年4月至2016年4月急诊护理监测的所有急诊护理接触数据；这涉及84,647次护理接触，55,061名患者。我们将途径急诊护理接触定义为在急诊护理途径内与不同医疗服务提供者的多次急诊护理接触，并区分与单一急诊医疗服务提供者的单次或重复护理接触。我们调查了链式护理中症状表现、诊断、前置时间、住院情况和死亡率的差异。
老年患者的急诊护理接触更常为途径接触，而非年轻患者（26%对16%；p < 0.0001）。老年患者更常被诊断为中风、肺炎或慢性阻塞性肺疾病加重，而年轻患者更常出现单纯挫伤或腹部症状。老年患者的途径前置时间比年轻患者长（中位数差异：33分钟；95%置信区间：25 - 40）。老年患者更常住院（71%对39%，p < 0.0001），且死亡率更高（2.0%对0.5%；p < 0.0001）。
与年轻患者相比，急诊护理途径中的老年患者有更频繁、更长时间的途径接触，且呈现出更复杂、危及生命的临床症状。应探索新的解决方案，以确保急诊护理途径对越来越多的老年人来说仍然可及、可用，并提供足够的质量。
