Geriatric screening in the emergency department increases consultations to geriatric medicine and physical and occupational therapy: A pre/post cohort study.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Academic Emergency Medicine Pub Date : 2024-11-01 Epub Date: 2024-06-14 DOI:10.1111/acem.14964
Katherine M Hunold, Jeffrey M Caterino, Christopher R Carpenter, Lorraine C Mion, Lauren T Southerland
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引用次数: 0

Abstract

Background: The Geriatric Emergency Department (ED) Guidelines recommend screening older patients for need for evaluation by geriatric medicine, physical therapy (PT), and occupational therapy (OT), but explicit evidence that geriatric screening changes care compared to physician gestalt is lacking. We assessed changes in multidisciplinary consultation after implementation of standardized geriatric screening in the ED.

Methods: Retrospective single-site observational cohort of older adult ED patients from 2019 to 2023 with three time periods: (1) preimplementation, (2) implementation of geriatric screening, and (3) postimplementation. Geriatric, PT, and OT consultations/referrals were available during all time periods. Descriptive analysis was stratified by disposition: discharged, observation and discharged, observation and hospital admission, and hospital admission. The independent variable was completion of three geriatric screening tools by ED nurses. The dependent variable was consultation and/or referral to geriatrics, PT, and OT. Secondary outcomes were disposition, ED revisits, and 30-day rehospitalizations.

Results: There were 57,775 qualifying ED visits of patients age ≥ 65 years during the time periods: implementation increased geriatric screening from 0.5% to 63.2%; postimplementation, discharge patients who received screening had more consultations/referrals to geriatrics (1.5% vs. 0.4%), PT (7.9% vs. 1.9%), and OT (6.5% vs. 1.2%) compared to unscreened patients. Patients observed and then discharged had more consultations/referrals to geriatrics (15.1% vs. 11.3%), PT (74.1% vs. 64.5%), and OT (65.7% vs. 56.5%). Admitted patients had no change in consultation rates. Geriatric screening was not associated with a change in 7-day ED revisits for discharged patients but was associated with decreased revisits for patients discharged from observation (11.6% vs. 42.9%, p < 0.001).

Conclusion: Geriatric screening was associated with increased consultations/referrals to geriatrics, PT, and OT in the ED and ED observation unit. This suggests that geriatric screening changes ED care for older adults.

急诊科的老年病筛查增加了老年医学和物理及职业治疗的咨询量:前后队列研究。
背景:老年病学急诊科(ED)指南建议对老年病人进行筛查,以确定是否需要由老年医学、物理治疗(PT)和职业治疗(OT)进行评估,但目前还缺乏明确的证据表明,老年病学筛查与医生态势疗法相比会改变护理方式。我们评估了在急诊室实施标准化老年病筛查后多学科会诊的变化:2019年至2023年老年急诊室患者的回顾性单点观察队列,分为三个时间段:(1)实施前,(2)实施老年病筛查,(3)实施后。在所有时间段内均可获得老年病学、康复治疗和康复治疗咨询/转诊。描述性分析按处置方式进行分层:出院、观察后出院、观察后入院和入院。自变量是急诊室护士完成三种老年病筛查工具的情况。因变量是咨询和/或转诊至老年病科、康复治疗师和职业治疗师。次要结果为处置、急诊室再次就诊和 30 天再次住院:在上述时间段内,共有 57,775 名年龄≥ 65 岁的患者到急诊室就诊:实施老年病筛查后,筛查率从 0.5% 提高到 63.2%;实施后,与未接受筛查的患者相比,接受筛查的出院患者接受老年病科(1.5% 对 0.4%)、康复治疗师(7.9% 对 1.9%)和康复治疗师(6.5% 对 1.2%)会诊/转诊的比例更高。接受观察后出院的患者接受老年病科(15.1% 对 11.3%)、康复治疗师(74.1% 对 64.5%)和定向行走治疗师(65.7% 对 56.5%)会诊/转诊的比例更高。入院患者的就诊率没有变化。老年病筛查与出院患者的 7 天急诊室复诊率变化无关,但与减少观察后出院患者的复诊率有关(11.6% 对 42.9%,P 结论:老年病筛查与出院患者的 7 天急诊室复诊率变化无关,但与减少观察后出院患者的复诊率有关:老年病筛查与急诊室和急诊室观察室老年病科、康复治疗师和康复治疗师咨询/转诊次数的增加有关。这表明老年病筛查改变了急诊室对老年人的护理。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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