Applying Geriatric Principles to Transitions of Care in the Emergency Department.
Applying Geriatric Principles to Transitions of Care in the Emergency Department.
复制标题
将老年原则应用于急诊室的护理过渡。
DOI：
10.1016/j.emc.2021.01.006
复制
发表时间：
2021-05
影响因子：
1.2
通讯作者：
Southerland LT
中科院分区：
文献类型：
--
作者：
Bambach K;Southerland LT
每次老年人从一个物理护理环境转移到另一个物理护理环境或新的提供者承担护理时，都会发生护理过渡。对于经常患有多种合并症的老年人来说，护理的转变是频繁的，需要跨多个护理环境的跨学科提供者团队（图1）。这种转变通常是无计划的，发生在基础疾病恶化或急性疾病或损伤导致急诊科（艾德）就诊时。这可能是由于身体虚弱，老年人身体机能正常，但没有身体或心理社会储备来弥补额外的伤害或疾病，或者由于潜在的医疗条件的严重性。多个专家提供者之间的门诊护理碎片化导致艾德成为老年护理中心的重要枢纽。艾德访视可能导致患者出院回到社区，接受新的护理计划，出院到新的护理机构，或住院。有充分记录的不良事件与转换到或从艾德。过渡期间的不良事件可能危及老年人及其亲人的生命或改变其生命，导致独立性和功能状态下降。1在艾德就诊的3个月内，几乎三分之一的老年人将经历不良后果。2许多不良事件是药物相互作用或副作用。超过三分之一的患者（38%）从艾德处方药物有潜在的药物相互作用的药剂师审查。[3]艾德的处方很复杂，因为患者自我报告的药物很少，老年患者平均服用的药物比他们报告的多3.8种。4此外，紧急服务提供者可能会觉得药物协调太困难
Transitions of care occur every time an older adult moves from one physical care setting to another or when a new provider assumes care. Transitions of care are frequent for older adults who often have multiple comorbidities requiring an interdisciplinary team of providers across multiple care settings (Figure 1). Such transitions are often unplanned and occur when either an exacerbation of an underlying illness or an acute illness or injury results in a visit to the Emergency Department (ED). This may be due to frailty, where an older person is functioning well but does not have the physical or psychosocial reserve to compensate for an additional injury or illness, or due to the severity of the underlying medical condition. Fragmentation of outpatient care between multiple specialist providers has resulted in the ED becoming an important hub at the center of geriatric care. The ED visit may result in discharge back to the community with a new care plan, discharge to a new care setting, or hospital admission.Adverse events with transitions to or from the ED are well documented. Adverse events during transitions can be life-threatening or life-altering for older adults and their loved ones, leading to a decline in independence and functional status. 1 Within 3 months of an ED visit, almost one-third of older adults will experience an adverse outcome. 2 Many of these adverse events are medication interactions or side effects. Over a third of patients (38%) prescribed medications from the ED have potential drug-drug interactions on pharmacist review. 3 Prescribing from the ED is complicated by the fact that patient self-report of medications is poor, with older patients taking on average 3.8 more medications than they report. 4 Additionally, emergency providers may feel medication reconciliation is too difficult
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影响因子：
5.9
作者：
Jain, Nelia;Bernacki, Rachelle E.
通讯作者：
Bernacki, Rachelle E.
影响因子：
1.8
作者：
Leamy, Kelly;Thompson, John;Mitra, Biswadev
通讯作者：
Mitra, Biswadev
影响因子：
3.4
作者：
Werner, Rachel M.;Konetzka, R. Tamara;Coe, Norma B.
通讯作者：
Coe, Norma B.
DOI：
10.1111/acem.13328
发表时间：
2018-01
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
--
作者：
Southerland LT;Vargas AJ;Nagaraj L;Gure TR;Caterino JM
通讯作者：
Caterino JM
影响因子：
2.2
作者：
Hastings, Susan N.;Barrett, Amanda;Schmader, Kenneth E.
通讯作者：
Schmader, Kenneth E.