专门的老年人急救小组和区域能否降低住院率？——一项观察性干预前后研究。

Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study.

机构信息

Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖS, Sjukhusbacken 10, 118 83, Stockholm, Sweden.

Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden.

出版信息

BMC Geriatr. 2021 Feb 10;21(1):115. doi: 10.1186/s12877-021-02044-w.

DOI:10.1186/s12877-021-02044-w

PMID:33568087

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7877031/

Abstract

BACKGROUND

Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frail patients, and the weak evidence of positive outcomes of using CGA in EDs pose barriers to introduce the guidelines. Dedicating an interprofessional team of regular ED medical and nursing staff and an older-friendly ED area can be another approach. Previous studies of geriatrician-led CGA in EDs have reported a reduced hospital admission rate. The aim of this study was to investigate whether a dedicated interprofessional emergency team also can reduce the hospital admission rate without the resources required by the formal use of CGA.

METHODS

An observational pre-post study at a large adult ED, where all patients 80 years or older arriving on weekdays in the intervention period from 2016.09.26 to 2016.11.28 and the corresponding weekdays in the previous year from 2015.09.28 to 2015.11.30 were included. In the intervention period, older patients either received care in the geriatric module by the dedicated team or in the regular team modules for patients of mixed ages. In 2015, all patients received care in regular team modules. The primary outcome measure was the total hospital admission rate and the ED length of stay was the secondary outcome measure.

RESULTS

We included 2377 arrivals in the intervention period, when 26.7% (N = 634) received care in the geriatric module, and 2207 arrivals in the 2015 period. The total hospital admission rate was 61.7% (N = 1466/2377) in the intervention period compared to 64.8% (N = 1431/2207) in 2015 (p = 0.03). The difference was larger for patients treated in the geriatric module, 51.1% compared to 62.1% (95% CI: 56.3 to 68.0%) for patients who would have been eligible in 2015. The ED length of stay was longer in the intervention period.

CONCLUSIONS

An interprofessional team and area dedicated to older patients was associated to a lower hospital admission rate. Further studies are needed to confirm the results.

摘要

背景

老年患者在急诊科的护理往往较为复杂。老年急诊科指南可以帮助应对这一挑战。然而，培训要求、使用耗时的综合老年评估（CGA）工具、缺乏识别脆弱患者的金标准以及在急诊科使用 CGA 的积极结果的证据不足，这些都成为引入指南的障碍。专门为老年患者配备多专业的急诊医疗和护理人员团队以及一个对老年人友好的急诊区域，也可以是另一种方法。以前的研究表明，由老年病医生主导的急诊科 CGA 可降低住院率。本研究旨在探讨专门的多专业急诊团队是否可以在不使用 CGA 的正式方法所需资源的情况下，降低住院率。

方法

这是一项在大型成人急诊科进行的观察性前后研究，所有在干预期（2016 年 9 月 26 日至 2016 年 11 月 28 日）和前一年同期（2015 年 9 月 28 日至 2015 年 11 月 30 日）工作日 80 岁及以上的患者都包括在内。在干预期间，老年患者要么由专门的团队在老年模块中接受治疗，要么在混合年龄患者的常规团队模块中接受治疗。2015 年，所有患者都在常规团队模块中接受治疗。主要结局指标是总住院率，急诊停留时间是次要结局指标。

结果

干预期间共收治 2377 例患者，其中 634 例（26.7%）接受老年模块治疗，2015 年同期收治 2207 例。干预期间的总住院率为 61.7%（1466/2377），而 2015 年为 64.8%（1431/2207）（p=0.03）。在老年模块中接受治疗的患者的差异更大，为 51.1%，而 2015 年符合条件的患者为 62.1%（95%可信区间：56.3 至 68.0%）。干预期间急诊停留时间较长。