基于老年医学综合评估的老年医学干预措施对急诊科评估的高危老年患者可避免的入院治疗的影响

Paula Fernández-Montalbán , Sara Martínez-Flores , María Mir-Montero , José Ramón Arribas López , Carlos Bibiano-Guillén , Fátima Brañas
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引用次数: 0

摘要

目的 了解基于老年医学综合评估(CGA)的老年医学干预措施对急诊科评估的高危老年患者可避免的入院治疗的影响。我们纳入了2018年10月1日至2020年1月31日期间在急诊科就诊且分诊风险筛查工具(TRST)评分≥2分的75岁以上患者。所有患者均由一名老年病学专家通过 CGA 进行评估。我们收集了患者前往急诊室的原因、老年病科采取的主要干预措施、是否需要入院或出院以及是否可以避免入院。我们进行了成本分析,计算方法是(床位/天×平均住院天数×避免入院次数)。73.5%的患者使用多种药物,平均 Charlson 指数为 2.5(5.6)。63.3%的患者能独立行走,20.8%的患者能独立进行基本的日常生活活动。59%的患者有认知障碍。91.5%的患者住在家中。到急诊室就诊最常见的原因是一般状态下降,占 22%,老年医学科最常见的干预措施是协助 35.4% 的患者做出决定,其次是将 32.7% 的患者转介到优先老年医学门诊护理中心。老年医学科采取的其他干预措施包括协助明确诊断(4.2%)、协助调整药物(8.5%)、转诊至标准老年医学护理路径(13.1%)、电话随访(4.2%)和/或与社会服务部门协调制定护理计划(11.2%)。结论 对急诊室有不良事件风险的老年患者,由老年医学部门协调的标准化 CGA 可减少入院次数和费用,因此应将其确立为良好临床实践的一项建议。
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Impact of a geriatric intervention based on the Comprehensive Geriatrics Assessment on avoidable admissions in older patients at risk evaluated in the Emergency Department

Objective

To know the impact of a geriatric intervention based on the Comprehensive Geriatric Assessment (CGA) on avoidable admissions in older patients at risk evaluated in the Emergency Department.

Method

Prospective observational unicenter study. We included patients, from October 1, 2018 to January 31, 2020, over 75 years who were attended at the Emergency Department with a Triage Risk Screening Tool (TRST) score  2. All patients were evaluated by a geriatrician through the CGA. The reasons for going to the Emergency room were collected and also the main intervention carried out by Geriatrics, whether admission or discharge was indicated and whether the admission was avoidable. We did a cost analysis calculating this by (bed/day × average stay × number of admissions avoided).

Results

We included 260 patients, 66% were women and the mean age was 86 years. 73.5% patients had polypharmacy, the mean Charlson index was 2.5 (5.6). 63.3% were independent for walking and 20.8% independent for basic activities of daily living. 59% had cognitive impairment. 91.5% lived at home. The most frequent reason for visiting the Emergency room was decline of general state in 22% and the most frequent intervention carried out by Geriatrics was assistance in the decision making process in 35.4% followed by referral to a preferential outpatient geriatric care circuit in 32.7%. Other interventions carried out by Geriatrics was assistance in clarifying diagnosis (4.2%), assistance in pharmacological adjustment (8.5%), referral to a standard geriatric care pathway (13.1%), telephone follow-up (4.2%) and/or coordination with Social Services for care planning (11.2%).

Including all patients, 29.2% required hospital admission and 70.8% were discharged. 40% admissions were avoided, which meant more than 540 thousand euros saved.

Conclusions

A standardized CGA coordinated by Geriatrics in older patients at risk of suffering adverse events in the Emergency room reduces admissions and costs, so it should therefore be established as a recommendation of good clinical practice.

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来源期刊
Revista Espanola de Geriatria y Gerontologia
Revista Espanola de Geriatria y Gerontologia Medicine-Medicine (miscellaneous)
CiteScore
1.90
自引率
0.00%
发文量
62
审稿时长
85 days
期刊介绍: Una revista de gran prestigio por sus artículos originales de investigación y revisiones. Permite cubrir todas las áreas de la medicina pero siempre desde la atención al paciente anciano, y está presente en los más reconocidos índices internacionales.
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