An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines.
An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines.
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DOI：
10.1111/acem.13328
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Caterino JM
中科院分区：
文献类型：
--
作者：
Southerland LT;Vargas AJ;Nagaraj L;Gure TR;Caterino JM
老年急诊科指南建议在急诊科（艾德）提供多学科老年评估，但这些评估可能难以协调，并可能延长住院时间。需要比典型的艾德停留时间更长的患者可以被安置在艾德观察单元（Obs Unit）。我们调查了在一个观察室为艾德患者提供多学科评估的效果。由老年医院咨询小组、物理治疗师、病例管理员和/或药剂师对所有观察室患者进行评价。使用任何或所有这些辅助咨询服务可以由观察室医生要求。对随机老年观察室患者进行回顾性图表审查，以评估这些咨询团队的咨询使用率和干预率。纳入了2015年10月至2017年3月期间IRB批准的每月观察单位质量数据库中所有≥ 65岁的患者。我们的质量数据库包括221名18个月以上的老年患者。平均年龄为73.3岁（65-96岁），55.2%为女性。平均观察住院时间为14.7小时（±6.5小时）。大多数（74.3%）从观察室出院，72小时艾德再犯率为3.6%。总体而言，40.3%的患者（n=89）要求至少一种多学科咨询服务。在80.0%接受物理治疗评估的患者（40例患者中的32例）中，100%接受药剂师评估的患者（5例患者中的5例），38%接受病例管理评估的患者（71例患者中的27例）和100%接受老年病医生评估的患者（8例患者中的8例）中，建议进行额外的干预或服务。仅5.4%（n=12）的患者接受了专门用于多学科评估的观察;这些患者的平均住院时间为12.2小时，住院率为41.7%。对老年患者进行多学科老年医学评估的要素在观察时间范围内是可行的，并导致有针对性的干预措施。一个观察单位是一个合理的设置，提供符合老年艾德指南的服务。
The Geriatric Emergency Department Guidelines recommend providing multidisciplinary geriatric assessment in the Emergency Department (ED), but these assessments can be difficult to coordinate and may prolong length of stay. Patients who need longer than a typical ED stay can be placed in an ED Observation Unit (Obs Unit). We investigated the effects of offering multidisciplinary assessments for ED patients in an Obs Unit. Evaluation by a geriatric hospital consultation team, physical therapist, case manager, and/or pharmacist was made available to all Obs Unit patients. Use of any or all of these ancillary consult services could be requested by the Obs Unit physician. A retrospective chart review of random older adult Obs Unit patients was done to assess rates of consult use and interventions by these consulting teams. All patients ≥ 65 years old in our IRB approved, monthly Obs Unit quality database from October 2015 through March 2017 were included. Our quality database included 221 older patients over 18 months. The average age was 73.3 years (range 65–96) and 55.2% were women. The average observation length of stay was 14.7 hours (±6.5 hours). The majority (74.3%) were discharged from the Obs Unit and 72 hour ED recidivism was 3.6%. Overall, at least one of the multidisciplinary consultant services were requested in 40.3% of patients (n=89). Additional interventions or services were recommended in 80.0% of patients evaluated by physical therapy (32 of 40 patients), 100% of those evaluated by a pharmacist (5 of 5 patients), 38% of those evaluated by case management (27 of 71 patients), and 100% of those evaluated by a geriatrician (8 of 8 patients). Only 5.4% (n=12) of patients were placed in observation specifically for multidisciplinary assessment; these patients had an average length of stay of 12.2 hours and an admission rate of 41.7%. Incorporating elements of multidisciplinary geriatric assessment for older patients is feasible within an observation time frame and resulted in targeted interventions. An Obs Unit is a reasonable setting to offer services in compliance with the Geriatric ED Guidelines.
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影响因子：
1.6
作者：
Foo, Chik Loon;Siu, Vivian Wing Yin;Seow, Eillyne
通讯作者：
Seow, Eillyne
DOI：
10.1111/j.1532-5415.1997.tb01485.x
发表时间：
1997-06-01
影响因子：
6.3
作者：
Gold, S;Bergman, H
通讯作者：
Bergman, H
影响因子：
3.6
作者：
Caterino, Jeffrey M.;Hoover, Emily M.;Moseley, Mark G.
通讯作者：
Moseley, Mark G.
DOI：
10.1136/bmj.d6553
发表时间：
2011-10-27
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Ellis G;Whitehead MA;Robinson D;O'Neill D;Langhorne P
通讯作者：
Langhorne P
影响因子：
3.3
作者：
Moseley, Mark G.;Hawley, Miles P.;Caterino, Jeffrey M.
通讯作者：
Caterino, Jeffrey M.