临床虚弱量表在急诊科使用是否可行？一项混合方法研究。

Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study.

机构信息

Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

出版信息

BMC Emerg Med. 2023 Oct 26;23(1):124. doi: 10.1186/s12873-023-00894-8.

DOI:10.1186/s12873-023-00894-8

PMID:37880591

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10601295/

Abstract

BACKGROUND

The Clinical Frailty Scale (CFS) is a frailty assessment tool used to identify frailty in older patients visiting the emergency department (ED). However, the current understanding of how it is used and accepted in ED clinical practice is limited. This study aimed to assess the feasibility of CFS in an ED setting.

METHODS

This was a prospective, mixed methods study conducted in three Swedish EDs where CFS had recently been introduced. We examined the completion rate of CFS assessments in relation to patient- and organisational factors. A survey on staff experience of using CFS was also conducted. All quantitative data were analysed descriptively, while free text comments underwent a qualitative content analysis.

RESULTS

A total of 4235 visits were analysed, and CFS assessments were performed in 47%. The completion rate exceeded 50% for patients over the age of 80. Patients with low triage priority were assessed to a low degree (24%). There was a diurnal variation with the highest completion rates seen for arrivals between 6 and 12 a.m. (58%). The survey response rate was 48%. The respondents rated the perceived relevance and the ease of use of the CFS with a median of 5 (IQR 2) on a scale with 7 being the highest. High workload, forgetfulness and critical illness were ranked as the top three barriers to assessment. The qualitative analysis showed that CFS assessments benefit from a clear routine and a sense of apparent relevance to emergency care.

CONCLUSION

Most emergency staff perceived CFS as relevant and easy to use, yet far from all older ED patients were assessed. The most common barrier to assessment was high workload. Measures to facilitate use may include clarifying the purpose of the assessment with explicit follow-up actions, as well as formulating a clear routine for the assessment.

REGISTRATION

The study was registered on ClinicalTrials.gov 2021-06-18 (identifier: NCT04931472).

摘要

背景

临床虚弱量表（CFS）是一种用于识别急诊科（ED）老年患者虚弱程度的虚弱评估工具。然而，目前对于它在 ED 临床实践中的使用和接受程度的了解有限。本研究旨在评估 CFS 在 ED 环境中的可行性。

方法

这是一项在瑞典三个 ED 进行的前瞻性、混合方法研究，CFS 最近在这些 ED 中引入。我们考察了 CFS 评估与患者和组织因素的完成率。还对工作人员使用 CFS 的经验进行了调查。所有定量数据均进行描述性分析，而自由文本评论则进行了定性内容分析。

结果

共分析了 4235 次就诊，其中 47%进行了 CFS 评估。80 岁以上患者的完成率超过 50%。低分诊优先级的患者评估程度较低（24%）。存在日间变化，早上 6 点至 12 点之间的到达率最高（58%）。调查的回复率为 48%。受访者对 CFS 的感知相关性和易用性的评分中位数为 5（IQR 2），最高分为 7。高工作量、健忘和危重病被列为评估的前三大障碍。定性分析表明，CFS 评估得益于明确的常规和对急诊护理的明显相关性。