Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients
Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients
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DOI：
10.1097/ta.0000000000001931
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发表时间：
2018-07-01
影响因子：
3.4
通讯作者：
Posluszny, Joseph A.
中科院分区：
文献类型：
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作者：
Engelhardt, Kathryn E.;Reuter, Quentin;Posluszny, Joseph A.
虚弱的老年创伤和急诊普通外科（TEGS）患者与非虚弱患者相比，住院时间更长，再入院率更高，出院后住院率更高。尽管国家创伤联盟呼吁采取行动，但很少有发表的前瞻性干预报告。这个质量改进项目的目的是首先制定一个脆弱的筛查计划，然后，如果虚弱，实施一种新的脆弱途径，以减少LOS，30天的再入院，和独立性的损失。方法这是一个前瞻性队列的所有老年（65岁）患者的研究前后，从2016年10月至2017年10月的TEGS服务。对所有患者进行为期3个月（干预前）的虚弱筛查，以获得基线结果。随后，虚弱的患者进入我们的虚弱路径（干预后）。使用非参数统计检验评估连续变量的显著差异;（2）在适当情况下，对分类变量使用Fisher精确检验。过程和结果的措施进行了evaluated.Results筛选的239例老年TEGS患者，70（29.3%）是体弱。所有TEGS老年患者在入院后24小时内进行筛查。实施虚弱路径后，虚弱患者的中位LOS从9天降至6天（p = 0.4），再入院率从36.4%降至10.2%（p = 0.04），独立性丧失降低40%（100% vs 60%; p = 0.01）。非体弱老年患者的结果没有不同cohols.CONCLUSIONS筛选虚弱，然后实施一个脆弱的途径降低LOS，独立性的损失，和30天的再入院率为体弱老年TEGS患者在一个单一的城市学术机构。该途径不需要额外的资源;相反，我们将重点转移到体弱患者，而不会对非体弱老年TEGS患者的结局产生负面影响。需要在更大的患者队列和不同的环境中实施这一途径，以确认我们的干预和改善结果之间的因果关系。证据等级治疗性研究，IV级。
BACKGROUND Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence.METHODS This was a before-after study of a prospective cohort of all geriatric (65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; (2) and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated.RESULTS Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4% to 10.2% (p = 0.04), and loss of independence decreased by 40%, (100% vs 60%; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts.CONCLUSIONS Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes.LEVEL OF EVIDENCE Therapeutic study, level IV.