Department of Medicine, University of Montreal, Montreal, QC, Canada.
Research Centre of the Geriatric University Institute of Montreal, Montreal, QC, Canada.
Eur Geriatr Med. 2021 Oct;12(5):921-929. doi: 10.1007/s41999-021-00517-0. Epub 2021 Jun 4.
The study aims to examine whether the use of "emergency room evaluation and recommendations" (ER) tool in daily ED practice reduces the length of stay in ED and hospital, and hospital admission in older patients visiting ED on stretcher.
A total of 3931 older patients visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) on stretcher were recruited in this non-randomized, pre-post intervention, single arm, prospective and longitudinal open-label trial. ED staff and patients were blinded of the ER score and patients received usual ED care over the observational phase, whereas ED staff were informed about the ER score and patients had usual care plus interventions based on tailor-made geriatric recommendations during the interventional phase. The length of stay in ED and in hospital, and hospital admission were the outcomes.
The ER recommendations were associated with increased length of stay in ED (β = 2.94 with P ≤ 0.001) and decreased length of stay in hospital (β = - 2.07 with P = 0.011). No effect was found for hospital admission (Odd Ratio (OR) = 0.92 with P = 0.182).
Emergency room evaluation and recommendations (ER) tool had mixed effects. Shorter hospital stay has been reported for older ED users hospitalized, but increased ED stay and no effects on hospital admission were found.
本研究旨在探讨在日常急诊实践中使用“急诊评估和建议”（ER）工具是否能缩短急诊科和医院的停留时间，以及减少使用担架就诊的老年患者的住院率。
这项非随机、前后干预、单臂、前瞻性和纵向开放标签试验共纳入了 3931 名在加拿大魁北克省蒙特利尔的犹太总医院使用担架就诊的老年患者。在观察阶段，ED 工作人员和患者对 ER 评分不知情，患者接受常规 ED 护理，而在干预阶段，ED 工作人员了解 ER 评分，患者接受常规护理和基于量身定制的老年建议的干预措施。主要结局是 ED 和医院的停留时间和住院率。
ER 建议与 ED 停留时间延长相关（β=2.94，P≤0.001），与医院停留时间缩短相关（β=−2.07，P=0.011）。但对住院率没有影响（比值比（OR）=0.92，P=0.182）。
急诊评估和建议（ER）工具的效果喜忧参半。对于住院的老年 ED 使用者，报告的住院时间缩短，但 ED 停留时间延长，住院率没有影响。
