Lim Fat Guillaume J, Gopaul Aquila, Pananos A Demetri, Taabazuing Mary-Margaret
Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine, Western University, London, ON N6A 3K7, Canada.
Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Geriatrics (Basel). 2022 Aug 8;7(4):81. doi: 10.3390/geriatrics7040081.
A growing number of Canadian older adults are designated alternate level of care (ALC) and await placement into long-term care (LTC) while admitted to hospital. This creates infrastructural challenges by using resources allocated for acute care during disproportionately long hospital stays. For ALC patients, hospital environments maladapted to their needs impart risk of healthcare-associated adverse events.
In this retrospective descriptive study, we examined healthcare-associated adverse events in 156 ALC patients, 65 years old and older, awaiting long-term care while admitted to two hospitals in London, Ontario in 2015-2018. We recorded incidence of infections and antimicrobial days prescribed. We recorded incidence of non-infectious adverse events including delirium, falls, venothrombotic events, and pressure ulcers. We used a restricted cubic spline model to characterize adverse events as a function of length of stay.
Patients waited an average of 56 ALC days (ranging from 6 to 333 days) before LTC placement, with seven deaths occurring prior to placement. We recorded 362 total adverse events accrued over 8668 ALC days: 94 infections and 268 non-infectious adverse events. The most common hospital-acquired infections were urinary-tract infections and respiratory infections. The most common non-infectious adverse events were delirium and falls. A total of 620 antimicrobial days were prescribed for infections.
ALC patients incur a meaningful and predictable number of adverse events during their stay in acute care. The incidence of these adverse events should be used to educate stakeholders on risks of ALC stay and to advocate for strategies to minimize ALC days.
越来越多的加拿大老年人被指定为替代护理级别（ALC），在住院期间等待入住长期护理（LTC）机构。这在相当长的住院时间内占用了分配给急性护理的资源，从而带来了基础设施方面的挑战。对于ALC患者而言，不适应其需求的医院环境会带来医疗相关不良事件的风险。
在这项回顾性描述性研究中，我们调查了2015年至2018年期间在安大略省伦敦市两家医院住院等待长期护理的156名65岁及以上的ALC患者的医疗相关不良事件。我们记录了感染发生率和抗菌药物使用天数。我们记录了非感染性不良事件的发生率，包括谵妄、跌倒、静脉血栓形成事件和压疮。我们使用受限立方样条模型将不良事件描述为住院时间的函数。
患者在入住LTC机构前平均等待56个ALC日（范围为6至333天），其中7人在入住前死亡。在8668个ALC日期间，我们共记录了362起不良事件：94起感染事件和268起非感染性不良事件。最常见的医院获得性感染是尿路感染和呼吸道感染。最常见的非感染性不良事件是谵妄和跌倒。共为感染开具了620个抗菌药物使用天数。
ALC患者在急性护理期间会发生数量可观且可预测的不良事件。这些不良事件的发生率应用于教育利益相关者关于ALC住院的风险，并倡导采取策略尽量减少ALC天数。
