Emergency Medicine, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands.
BMJ Open. 2021 Aug 4;11(8):e049543. doi: 10.1136/bmjopen-2021-049543.
More older patients are presenting to the emergency department (ED). It is important to know why these patients present and if the ED is the best place for them to receive the care they need. The primary aim of this study was to identify organisational-related, technical-related, healthcare worker-related and patient-related factors leading to ED presentations of older patients. The secondary aim was to determine patients' and caregivers' perspectives on what kinds of ED presentations are potentially preventable.
This is a prospective observational study. A root cause analysis was performed by the Prevention and Recovery Information System for Monitoring and Analysis method. It used basic administrative data collected from patient records and interviews of patients, general practitioners (GPs) and physicians at the ED.
The ED of an academic hospital in the Netherlands.
100 older patients (aged ≥70 years) who attended the ED between November 2017 and March 2018.
In 100 patients presenting to the ED, 159 factors that contributed to presentation were identified; most of these factors were related to underlying diseases (59%) and patient-related factors (18%). These presentations were considered potentially preventable by 23% of the physicians at the ED and 21% of the GPs, but only 10% of the patients. In only four cases was there overall agreement between the patients and the healthcare workers.
The most frequent underlying factors contributing to an ED presentation in older patients are disease-related and patient-related. The low percentage of ED presentations considered potentially preventable shows that a 'preventable ED presentation' is difficult to define and therefore interventions to reduce them are unlikely to be simple. Novel solutions within the acute care pathway are required in order to deliver care of optimal quality and safety to older patients.
越来越多的老年患者到急诊科就诊。了解这些患者就诊的原因以及急诊科是否是他们获得所需治疗的最佳场所非常重要。本研究的主要目的是确定与组织相关、技术相关、医护人员相关和患者相关的因素，这些因素导致老年患者到急诊科就诊。次要目的是确定患者和护理人员对哪些急诊科就诊可能是可以预防的看法。
这是一项前瞻性观察研究。采用预防和恢复信息系统监测和分析方法进行根本原因分析。它使用从患者记录和对急诊科患者、全科医生和医生的访谈中收集的基本行政数据。
荷兰一家学术医院的急诊科。
2017 年 11 月至 2018 年 3 月期间到急诊科就诊的 100 名年龄≥70 岁的老年患者。
在 100 名到急诊科就诊的患者中，确定了 159 个导致就诊的因素；这些因素大多与基础疾病（59%）和患者相关因素（18%）有关。急诊科的 23%的医生和全科医生认为这些就诊可能是可以预防的，但只有 10%的患者认为是可以预防的。在患者和医护人员之间，只有 4 例存在总体一致性。
导致老年患者到急诊科就诊的最常见的潜在因素是疾病相关和患者相关的。考虑到急诊科就诊可能是可以预防的比例较低，这表明“可预防的急诊科就诊”难以定义，因此减少此类就诊的干预措施不太可能简单。需要在急性护理途径内找到新的解决方案，以便为老年患者提供最佳质量和安全的护理。
