Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
Department of Public Health, University of Helsinki, Helsinki, Finland.
Scand J Caring Sci. 2023 Jun;37(2):582-594. doi: 10.1111/scs.13148. Epub 2023 Jan 30.
People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED.
We aim to assess the performance of acute care services provided to people living in nursing homes or long-term homecare, focusing on ED transfer prevention, safety, cost-effectiveness and experiences.
MATERIALS & METHODS: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were eligible for inclusion if they were peer-reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long-term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins-I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE.
Fifteen relevant original studies were found-all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low.
Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster-randomised or quasi-experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost-effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020.
居住在养老院的人面临着前往急诊部（ED）就诊的风险。正在开发外展服务以防止不必要地转至 ED。
我们旨在评估为居住在养老院或长期家庭护理中的人提供的急性护理服务的性能，重点关注 ED 转诊预防、安全性、成本效益和体验。
本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）。如果研究是同行评审的，并检查了专门为养老院或长期家庭护理中的人提供护理的急性外展服务，则符合纳入标准。该服务模式也可以具有预防成分。搜索的数据库是 Scopus 和 CINAHL。此外，还使用了 Robins-I 和 SIGN 清单。主要结局是预防 ED 转院或住院，以及复合结局是不良事件（死亡/紧急医疗服务或与同一临床状况相关的 ED 就诊）。使用 GRADE 对结果进行分级。
共发现 15 项相关原始研究 - 均为观察性研究，且均聚焦于养老院。具有预防成分的急性外展服务预防 ED 转院或住院的证据确定性较低。利益相关者对这些服务感到满意。仅用于预防 ED 转院或住院的急性外展服务的证据确定性非常低且结论不确定。不良事件报告不一致，证据确定性低。
已发表的数据可能支持为居住在养老院的人采用具有预防成分的急性外展服务，以减少 ED 转院、住院和可能的成本。如果启动外展服务，建议采用集群随机或准实验研究设计，以评估服务的有效性和安全性。还需要更多关于成本效益和利益相关者满意度的证据。系统评价注册编号：PROSPERO CRD42020211048，注册日期：2020 年 9 月 25 日。
