M G A M van der Velde, M A C Jansen, F Derkx-Verhagen, I P B Tournoij, F S Jonkers, H R Haak, M N T Kremers
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引用次数: 0
摘要
目的：管理在急诊科（ED）就诊的老年患者提出了挑战，因为他们倾向于提出非特异性投诉（NSC）。随着人口老龄化和ED过度拥挤，NSC的重要性预计会增加。因此，我们实施了一个结构化的护理途径来解决NSC演示的复杂性。本研究的目的是评估这种护理途径的有效性。方法：采用风险分层、标准化评估和诊断测量等方法，对NSC护理路径进行前后对比研究。对照组在实施前分别在两家医院（1院和2院）接受标准治疗。患者入组时间为2021年4月至2024年11月。结果包括在急诊科（LOS-ED）和住院时间（LOS-H）、复诊次数、诊断完整性（即所有急诊科和出院诊断之间100%一致）和感知护理质量。结果：本研究共纳入对照组164例，干预组235例。中位LOS-ED和LOS-H在对照组和干预组之间无显著差异。护理途径的实施在提高诊断完整性方面没有显著趋势（47.1% vs 37.2%, p = 0.096）。这可能与观察到的30天再入院减少无关（7.5% vs. 12.7%, p = 0.256）。患者报告的结果表明对护理质量有积极的体验。结论：护理途径并没有像假设的那样改善LOS-ED和LOS-H，可能是由于后勤障碍和患者的可变性。然而，趋势表明诊断的完整性得到改善，30天再入院率减少。需要进一步的研究计划来提高患者的预后和对NSC患者的护理。试验注册号：NL8960，日期：9-10-2020。
Evaluation of a care pathway for older adults presenting with nonspecific complaints at the emergency department: a before-and-after study.
Purpose: Managing older patients presenting at the Emergency Department (ED) poses challenges due to their predisposition to present with nonspecific complaints (NSC). With an ageing population and ED overcrowding, significance of NSC is expected to grow. Therefore, we implemented a structured care pathway to address the complexity of NSC presentations. The aim of this study is to evaluate the effectivity of this care pathway.
Methods: We conducted a before-and-after study to evaluate the NSC care pathway, which included risk stratification, standardized assessment and diagnostic measurements. A control group receiving standard care was established in two hospitals (hospital 1 and 2) before implementation. Patient enrollment occurred from April 2021 to November 2024. Outcomes included length of stay in the ED (LOS-ED) and in hospital (LOS-H), revisits, diagnostic completeness (i.e. 100% agreement between all ED and hospital discharge diagnoses) and perceived quality of care.
Results: In total, 164 control and 235 intervention patients were included in this study. Median LOS-ED and LOS-H did not show significant differences between the control and intervention patients. Implementation of the care pathway showed non-significant trends towards improved diagnostic completeness (47.1% vs 37.2%, p = 0.096). This might be associated with the non-significant observed decrease in 30-day readmissions (7.5% vs. 12.7%, p = 0.256). Patient-reported outcomes indicated a positive experience with the quality of care.
Conclusion: The care pathway did not improve LOS-ED and LOS-H as hypothesized, possibly due to logistical barriers and patient variability. However, trends suggested improved diagnostic completeness and fewer 30-day readmission rates. Further research initiatives are needed to enhance patient outcomes and care for NSC patients.
期刊介绍：
European Geriatric Medicine is the official journal of the European Geriatric Medicine Society (EUGMS). Launched in 2010, this journal aims to publish the highest quality material, both scientific and clinical, on all aspects of Geriatric Medicine.
The EUGMS is interested in the promotion of Geriatric Medicine in any setting (acute or subacute care, rehabilitation, nursing homes, primary care, fall clinics, ambulatory assessment, dementia clinics..), and also in functionality in old age, comprehensive geriatric assessment, geriatric syndromes, geriatric education, old age psychiatry, models of geriatric care in health services, and quality assurance.
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