Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units
Redesigned Geriatric Emergency Care May Have Helped Reduce Admissions Of Older Adults To Intensive Care Units
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DOI：
10.1377/hlthaff.2014.0790
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发表时间：
2015-05-01
期刊：
影响因子：
9.7
通讯作者：
Hwang, Ula
中科院分区：
文献类型：
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作者：
Grudzen, Corita;Richardson, Lynne D.;Hwang, Ula
纽约市西奈山医疗中心（Mount Sinai Medical Center）的一个流程改进团队负责通过应用姑息治疗原则转变老年急诊护理，开发了GEDI WISE（通过劳动力、信息和结构增强实现老年急诊科护理创新）模型。该模型为急诊科（ED）和辅助工作人员引入了劳动力增强，包括角色重新定义、再培训和姑息治疗原则教育。现有的急诊科分诊护士筛选65岁及以上的患者，以确定急诊科重访和再入院的高风险患者。经过全面培训后，这些护士对符合筛选标准的急诊科访客进行了筛查，只有6%除外。新聘用的急诊科护士确定适合和渴望姑息治疗和临终关怀的高危患者，然后加快转诊。在2011年1月至2013年5月期间，重症监护病房的老年急诊科入院比例大幅下降，从2.3%降至0.9%，估计为联邦医疗保险节省了300多万美元。这些入院人数的下降不能肯定地归因于GEDI WISE项目，因为在研究期间实施了其他老年护理创新。GEDI WISE项目目前正在西奈山医院和两个伙伴医院开展，它们对老年急救护理的质量和价值的潜在影响将继续得到检验。
Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined.