Nova Amanda A, Heckman George A, Gill-Chawla Navjot, Miles Amy, Costa Andrew P, Sinha Samir K, Jantzi Micaela, Hirdes John P, Hébert Paul C
School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
LUCAS Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2025 Feb;73(2):431-444. doi: 10.1111/jgs.19253. Epub 2024 Oct 31.
Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics.
We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression.
We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures.
The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.
老年急诊科指南建议优化对有复杂需求的老年患者的护理转接。在本研究中，我们调查了具有高风险特征并前往急诊科就诊的老年人向包括职业治疗、物理治疗、营养师、社会工作、家庭护理和专业老年服务在内的跨专业服务机构的转诊模式。
我们招募了2017年4月至2018年7月期间前往加拿大安大略省、魁北克省和纽芬兰省10家急诊科就诊的社区居住老年人。为了观察急诊科的护理过程，我们基于interRAI急诊筛查工具和急诊接触评估开展了两阶段的高风险病例查找和重点综合评估流程，以识别和描述高风险老年人。我们使用描述性统计和逻辑回归分析了二手数据。
我们用急诊筛查工具筛查了5265人，用急诊接触评估进一步评估了1479人，并分析了用急诊接触评估进行评估的1055名社区居住老年人的子集数据。我们研究样本中的参与者平均年龄为83岁，58%为女性，许多人有认知、功能障碍和社会需求的复杂负担。在这个高需求样本中，超过一半的人被转介到一般家庭护理服务（62.7%）、职业治疗（59.3%）和物理治疗服务（55.2%），而16%的人被转介到专业老年服务。我们还发现跨专业转诊与评估紧急算法和机构风险量表之间存在显著的正相关。转介到跨专业服务的最重要决定因素是医院所在省份、功能、临床和社会负担以及支持措施。
所确定的转诊模式表明，在我们调查的加拿大急诊科中，患者需求和风险强度并不总是指导转诊模式。我们建议急诊科严格审查其文件记录和转诊系统在支持以患者为中心的护理提供方面的适当性。
