Ackermann R J, Kemle K A, Vogel R L, Griffin R C
Department of Family and Community Medicine, Mercer University School of Medicine, Macon, GA, USA.
Ann Emerg Med. 1998 Jun;31(6):749-57. doi: 10.1016/s0196-0644(98)70235-5.
To describe a community's experience with the use of emergency department services by nursing home residents.
We performed a retrospective chart review of a population-based cohort of nursing home residents in an urban county in central Georgia with 10 nursing homes (1,300 beds) and 4 hospital-based EDs. All ED visits by nursing home residents during 1995 were analyzed. Demographic data, timing of the visit, chief complaint, tests and treatments, disposition, and financial charges were recorded. Further, we calculated the number of ED visits per 100 nursing home patient-years.
A total of 873 nursing home residents made 1,488 ED visits. Mean age was 76.0 years; 66.4% were female, and 55.2% were white. Of the transfers, 42.9% occurred during regular working hours. The most common chief complaints were respiratory symptoms (14.4%), altered mental status (10.1%), gastrointestinal symptoms (9.9%), and falls (8.2%); 101 patients (6.8%) were transferred for malfunction of a gastrostomy tube. The most common laboratory tests were complete blood cell count (69.5%), chest radiograph (52.0%), electrocardiogram (45.0%), urinalysis (42.7%), and determination of electrolytes (42.7%). A total of 42.4% of the ED visits led to admission to the hospital. From the 10 nursing homes, there were 110 ED visits per 100 patient-years. A 3.5-fold difference in ED use among these nursing homes could not be explained by age, gender, or other factors. The average .charge per ED visit was $1,239.
Elders living in nursing homes are frequently transferred to EDs for costly medical evaluations, and more than 40% of such visits lead to admission to the hospital.
描述养老院居民使用急诊科服务的情况。
我们对佐治亚州中部一个城市县的10家养老院（1300张床位）和4家医院急诊科的以人群为基础的养老院居民队列进行了回顾性病历审查。分析了1995年期间养老院居民的所有急诊科就诊情况。记录了人口统计学数据、就诊时间、主要症状、检查和治疗、处置情况以及费用。此外，我们计算了每100名养老院患者年的急诊科就诊次数。
共有873名养老院居民进行了1488次急诊科就诊。平均年龄为76.0岁；66.4%为女性，55.2%为白人。在转诊中，42.9%发生在正常工作时间。最常见的主要症状是呼吸道症状（14.4%）、精神状态改变（10.1%）、胃肠道症状（9.9%）和跌倒（8.2%）；101名患者（6.8%）因胃造瘘管故障而转诊。最常见的实验室检查是全血细胞计数（69.5%）、胸部X光片（52.0%）、心电图（45.0%）、尿液分析（42.7%）和电解质测定（42.7%）。共有42.4%的急诊科就诊导致住院。在这10家养老院中，每100患者年有110次急诊科就诊。这些养老院之间急诊科使用情况的3.5倍差异无法用年龄、性别或其他因素来解释。每次急诊科就诊的平均费用为1239美元。
住在养老院的老年人经常因昂贵的医学评估而被转诊至急诊科，且超过40%的此类就诊导致住院。
