Tracey F, Taylor I C, McConnell J G
Elderly Care Unit, Coleraine Hospital.
Ulster Med J. 1998 May;67(1):36-40.
Assessment and care management (ACM) of elderly patients prior to discharge from hospital has been in place since 1993. It involves a complex multi-disciplinary assessment of needs which may delay discharge from hospital. We prospectively studied the process of ACM in a group of patients discharged from hospital over a three month period. The times taken for completion of the necessary reports, and any delays in the process were recorded. The times of each individual step in the process were correlated to overall length of stay and to the length of the care management process. The effect of intercurrent illnesses or other delays was studied. Of the available sample (n = 83), 16 patients died and two required long term hospital care. The median length of stay of the remainder (n = 65) was 36 days (range 5-149 days). The median time from the start of the ACM process to discharge was 22 days (0-89 days). The strongest correlation with total length of stay was the time from admission until ACM commenced (rho = 0.661, p < 0.0001). The time spent in the ACM process was related strongly to the time taken for the Care Manager to process the applications (rho = 0.682, p < 0.0001). Delay was recorded in 17 (24%) cases, resulting in an increased length of stay (p < 0.001). While care management may help in appropriate placement after hospital discharge, these results suggest that it is prone to delays outside the hospital setting. Such delays result in patients waiting in hospital for care packages to be set up in the community. This has implications for acute hospital services.
自1993年起，医院便开始对老年患者出院前进行评估与护理管理（ACM）。这涉及对需求进行复杂的多学科评估，而这可能会延迟患者出院。我们对一组在三个月内出院的患者的ACM流程进行了前瞻性研究。记录了完成必要报告所需的时间以及流程中的任何延迟情况。将流程中每个单独步骤的时间与住院总时长以及护理管理流程的时长进行了关联分析。研究了并发疾病或其他延迟因素的影响。在可获取的样本（n = 83）中，16名患者死亡，2名患者需要长期住院护理。其余患者（n = 65）的住院中位时长为36天（范围为5 - 149天）。从ACM流程开始到出院的中位时间为22天（0 - 89天）。与住院总时长相关性最强的是从入院到ACM开始的时间（rho = 0.661，p < 0.0001）。在ACM流程中花费的时间与护理经理处理申请所需的时间密切相关（rho = 0.682，p < 0.0001）。17例（24%）出现了延迟情况，导致住院时长增加（p < 0.001）。虽然护理管理可能有助于患者出院后得到妥善安置，但这些结果表明，在医院外的环境中，护理管理容易出现延迟。这种延迟导致患者在医院等待社区护理套餐的设立。这对急性医院服务产生了影响。
