Hsu Hung-Lin, Ho Chung-Han, Lin Ying-Jia, Tsai Kang-Ting, Yang Pei-Chi, Hsu Shu-Lien, Peng An-Chi, Hsu Chien-Chin, Ho Sam Yu-Chieh, Huang Chien-Cheng
Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
Front Med (Lausanne). 2024 Dec 16;11:1444724. doi: 10.3389/fmed.2024.1444724. eCollection 2024.
Transitional care in the emergency department (ED) has the potential to improve outcomes for older patients, but the specific population benefits from it and impact in Taiwan remain unclear. Therefore, we conducted this study.
An interdisciplinary team comprising emergency physicians, dedicated transitional care nurse (TCN), nurse practitioners, nurses, geriatricians, and social workers was established at a tertiary medical center. TCN conducted screenings of ED patients (≥75 years) awaiting hospitalization to identify those in need of social or care support and aid as required. The team held regular meetings to address transitional care challenges. A retrospective analysis was conducted, comparing patients who received transitional care with those who did not, between February 1, 2022, and October 31, 2022, followed by a three-month outcome assessment.
We successfully implemented a novel ED transitional care model, involving 183 patients with TCN assistance and 374 patients without. Compared to patients without TCN, those with TCN were older, had more underlying comorbidities, required more nasogastric feeding and Foley indwelling, and had higher rates of hospice and palliative care. The common needs for TCN included providing home care instructions to a foreign caregiver (38.4%), long-term care referral (30.0%), care instructions for family members of older adults in long-term care facilities (26.3%), social worker referral (3.2%), and home healthcare referral (2.1%). Follow-up analysis showed no significant outcome differences between the two cohorts.
The model we implemented identified the population benefiting from this service. Despite the frailty of patients receiving TCN, their outcomes were not inferior, suggesting the potential benefits of TCN for this population. Further research is warranted.
急诊科的过渡性护理有可能改善老年患者的治疗结果，但在台湾，哪些特定人群能从中受益以及其影响仍不明确。因此，我们开展了这项研究。
在一家三级医疗中心成立了一个跨学科团队，成员包括急诊医师、专职过渡性护理护士（TCN）、执业护士、护士、老年病科医生和社会工作者。TCN对等待住院治疗的急诊科患者（≥75岁）进行筛查，以确定那些需要社会或护理支持并根据需要提供援助的患者。该团队定期开会以应对过渡性护理挑战。进行了一项回顾性分析，比较了2022年2月1日至2022年10月31日期间接受过渡性护理的患者和未接受过渡性护理的患者，随后进行了为期三个月的结果评估。
我们成功实施了一种新型的急诊科过渡性护理模式，其中183名患者得到了TCN的协助，374名患者未得到协助。与没有TCN协助的患者相比，有TCN协助的患者年龄更大，有更多的基础合并症，需要更多的鼻饲和留置导尿管，并且临终关怀和姑息治疗的比例更高。TCN的常见需求包括向外国护理人员提供家庭护理指导（38.4%）、长期护理转诊（30.0%）、为长期护理机构中老年人的家庭成员提供护理指导（26.3%）、社会工作者转诊（3.2%）和家庭医疗保健转诊（2.1%）。随访分析显示两组之间的结果没有显著差异。
我们实施的模式确定了能从这项服务中受益的人群。尽管接受TCN协助的患者身体虚弱，但他们的治疗结果并不差，这表明TCN对这一人群可能有益。有必要进行进一步研究。
