Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
J Am Med Dir Assoc. 2021 Apr;22(4):907-912.e1. doi: 10.1016/j.jamda.2020.06.043. Epub 2020 Aug 11.
High rates of adverse events (AEs) are reported for post-acute and long-term care settings (PA/LTC: skilled nursing facilities, inpatient rehabilitation centers, long-term acute care facilities, and home health). However, emergency department (ED)-based studies in this area are lacking. We describe all-cause harm among patients from PA/LTC settings seen in the ED.
Retrospective observational study using the ED Trigger Tool, with dual independent nurse reviews of 5582 ED records with triggers (findings increasing the likelihood of an AE) and confirmatory physician review of putative AEs.
We captured data for all adult patients at an urban, academic ED over a 13-month period (92,859 visits). PA/LTC patients were identified using a computerized ED Trigger Tool and manual review (κ = 0.85).
We characterize the AEs identified by severity and type using the ED Taxonomy of Adverse Events, and whether the AE occurred in the ED or was present on arrival. We estimate population AE rates using inverse probability weighting.
Compared with non-PA/LTC patients, PA/LTC patients (4.4% of population; 8.2% of our sample) tended to be older (median age 69 vs 50 years), with comparable sex ratios (54% female overall). PA/LTC patients accounted for 21% of all AEs (26% present on arrival; 13% in ED). Rates of AEs occurring in the ED were comparable after matching on age. Present on arrival AEs from a PA/LTC setting were most commonly related to patient care (39%), medication (34%), and infections (16%).
PA/LTC patients account for a small proportion of ED visits but experience a disproportionate number of AEs that are primarily present on arrival and patient-care related, and contribute to an admission rate double that for non-PA/LTC patients. Arguably, this cohort represents PA/LTC patients with the most severe AEs. Understanding these AEs may help identify high-yield targets for quality improvement.
在康复后和长期护理机构（PA/LTC：熟练护理设施、住院康复中心、长期急性护理设施和家庭健康）中，报告了高比例的不良事件（AE）。然而，在该领域缺乏基于急诊部（ED）的研究。我们描述了在 ED 中观察到的来自 PA/LTC 环境的所有原因伤害。
使用 ED 触发工具进行回顾性观察性研究，对 5582 份具有触发因素（增加 AE 可能性的发现）的 ED 记录进行双重独立护士审查，并对假定的 AE 进行确认性医生审查。
我们在 13 个月的时间内（92859 次就诊）收集了城市学术 ED 中所有成年患者的数据。使用计算机化的 ED 触发工具和手动审查来识别 PA/LTC 患者（κ=0.85）。
我们使用 ED 不良事件分类法来描述根据严重程度和类型确定的 AE，并确定 AE 是在 ED 发生还是在到达时存在。我们使用逆概率加权估计人群 AE 率。
与非 PA/LTC 患者相比，PA/LTC 患者（占人群的 4.4%；我们样本的 8.2%）年龄较大（中位数年龄 69 岁 vs 50 岁），性别比例相似（总体女性占 54%）。PA/LTC 患者占所有 AE 的 21%（26%在到达时存在；13%在 ED 中）。在年龄匹配后，ED 中发生 AE 的比率相似。来自 PA/LTC 环境的到达时存在的 AE 最常见于患者护理（39%）、药物（34%）和感染（16%）。
PA/LTC 患者占 ED 就诊的一小部分，但经历了不成比例数量的 AE，这些 AE 主要是到达时存在且与患者护理相关，并导致入院率是非 PA/LTC 患者的两倍。可以说，这一组代表了 PA/LTC 患者中最严重的 AE。了解这些 AE 可能有助于确定提高质量的高收益目标。
