[A prospective study on the effectiveness of a project for early discharge of elderly and frail patients from the emergency department].

Studio prospettico sull'efficacia di un progetto di dimissione difficile e precoce dal Pronto Soccorso di soggetti anziani e fragili.

Publisher: Il Pensiero Scientifico Editore Country of Publication: Italy NLM ID: 100901776 Publication Model: Print Cited Medium: Print ISSN: 1592-5986 (Print) Linking ISSN: 15925986 NLM ISO Abbreviation: Assist Inferm Ric

Original Publication: Roma : Il Pensiero Scientifico Editore

Community Health Nursing* ; Emergency Service, Hospital*/standards ; Emergency Service, Hospital*/statistics & numerical data ; Emergency Service, Hospital*/trends ; Frail Elderly*/statistics & numerical data; Length of Stay/*statistics & numerical data ; Patient Discharge/*standards ; Patient Readmission/*statistics & numerical data; Acute Disease/mortality ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease/mortality ; Feasibility Studies ; Female ; Group Homes/statistics & numerical data ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Patient Discharge/trends ; Prospective Studies ; Research Design ; Residential Facilities/statistics & numerical data ; Risk Assessment

Objective: Frail patients have increased chances of access to Emergency Department (ED) and hospital admission. ED discharge of frail patients (FP) implies high risk of poor outcome. A program of early ED discharge of FPs managed by community nurses (CN) for patients whose hospitalization is not indicated, but cannot be discharged is described.
Methods: Prospective observational study. A CN, in cooperation with other professionals, assessed the feasibility of discharge and activated the appropriate facilities for a safe patient return to the community. Patients' length of stay in ED, mortality and readmission rate to ED 3 months after discharge were measured.
Results: The mean age of the 210 enrolled patients was 82.9 years. The reasons for ED access were either acute or worsened chronic diseases, mainly related to orthopedic/traumatic events and pain. Ninety-two persons were sent back home and 118 to residential facilities. In the following 3 months, mortality was 15.7%; almost 36% of discharged patients had at least one access to hospital and the overall readmission rate was 55.7%, higher in sent home group.
Discussion: CNs, when integrated with other ED staff, can successfully manage early discharges of 'at risk' patients. The high readmission rate may reflect some enduring difficulties to manage in the community, problems traditionally treated in hospital.

Date Created: 20111115 Date Completed: 20120210 Latest Revision: 20120327

20240829

10.1702/970.10585

22076624