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.
A prospective study on the effectiveness of a project for early discharge of elderly and fragile patients from Emergency Department
Sanson G
2011-01-01
Abstract
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.Pubblicazioni consigliate
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