Care pathways in older patients seen in a multidisciplinary same day emergency care (SDEC) unit

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(1)

Published: Jan. 1, 2024

Abstract Background Same day emergency care (SDEC) services are being advocated in the UK for frail, older patients whom hospitalisation may be associated with harm but there few data on ‘ambulatory pathway’. We therefore determined patient pathways pre- and post-first assessment a SDEC unit focussed people. Methods In consecutive patients, we prospectively recorded follow-up service reviews (face-to-face, telephone, Hospital-at-Home domiciliary visits), outpatient referrals (e.g. to specialist clinics, imaging, community/voluntary/social services), hospital admissions <30 days. first 67 also healthcare interactions (except GP attendances) 180 days assessment. Results Among 533 (mean/SD age = 75.0/17.5 years, 246, 46% deemed frail) assessed an unit, 210 were admitted within 30 (152 immediately). 381(71%) remaining initially ambulatory, 587 747 other (mean 3.5 per patient) only 34 (9%) discharged no further follow-up. subset (n 67), number of ‘healthcare days’ was greater post- versus pre-SDEC 26/27 13/22 days, P 0.003) even after excluding admission frail non-frail patients. Discussion Conclusion older, 2-fold increase frequency complex involving multiple services. Our findings have implications development admission-avoidance models including cost-effectiveness optimal delivery multi-dimensional aspects acute geriatric ambulatory setting.

Language: Английский

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A new approach to getting simulation models used in healthcare: An example from emergency care

Journal of the Operational Research Society, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 12

Published: March 28, 2025

Language: Английский

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Factors associated with delayed order-to-administration time in the emergency department: a retrospective analysis

BMC Emergency Medicine, Journal Year: 2025, Volume and Issue: 25(1)

Published: April 28, 2025

Timely medication administration in the emergency department (ED) is critical for improving patient outcomes. This study aimed to identify predictors of delayed order-to-administration (OTA) time, defined as exceeding 30 min stat medications. A retrospective analysis was conducted ED a 1,000-bed tertiary hospital. Patients aged 20 years or older who received medications between June 1 and August 31, 2020, were included. Only first order per analyzed. Data on demographics, triage characteristics, environmental factors, prescription details, OTA times extracted from hospital's electronic medical record nursing information system. Multivariable logistic regression with backward elimination used delays. Among 11,429 visits included, 9.9% experienced delays min. Predictors higher odds delay included age (adjusted ratio [aOR]: 1.01, 95% CI: 1.00-1.01), female sex (aOR: 1.49, 1.31-1.69), limited mobility 1.38, 1.17-1.63 ambulatory assistance; aOR: 1.24, 1.03-1.48 non-ambulatory patients), trauma 1.35, CI:1.09-1.66), hourly 1.07, 1.05-1.10), concurrent intravenous fluid use (aOR:1.42, CI:1.04-1.93), blood tests 1.73, 1.30-2.30), radiography 2.22, 1.87-2.64), computed tomography 1.57, 1.37-1.80). Reduced observed among patients level compared 3 (aOR 0.25, CI:0.16-0.39), those arriving during night shifts day 0.33, 0.18-0.63), receiving intramuscular 0.71; CI, 0.55-0.93). Several patient, environmental, diagnostic-related factors associated administration. Understanding these may help inform strategies optimize workflows. Further research warranted validate findings other settings. Not applicable.

Language: Английский

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Measuring health-related quality of life of older people with frailty receiving acute care: feasibility and psychometric performance of the EuroQol EQ-5D

BMC Emergency Medicine, Journal Year: 2023, Volume and Issue: 23(1)

Published: Nov. 19, 2023

Abstract Background Although outcome goals for acute healthcare among older people living with frailty often include Health-Related Quality of Life (HRQoL) and other patient-reported measures (PROMs), current quality metrics usually focus on waiting times survival. Lay patient review have identified the EuroQol EQ-5D as a candidate measure this setting. This research appraised feasibility, psychometric performance, respondents’ outcomes in Methods People aged 65 + Clinical Frailty Scale (CFS) 5–8 were recruited from eight UK hospitals’ emergency care admissions settings. They completed five-level EQ-VAS. Feasibility was assessed completion completeness. For reliability, response distributions internal consistency analysed. Finally, EQ-Index values compared demographic characteristics service construct validity. Results The 232 participants 65–102. 38% responded departments 62% wards. Median time 12 (IQR, 11) minutes. 98% responses complete. had acceptable distribution (SD 1.1–1.3) (Cronbach’s alpha 0.69). EQ-VAS demonstrated midpoint pattern. 0.574 0.410) related positively increasing age ( p = 0.010) negatively CFS < 0.001). Participants higher more frequent problems mobility, self-care, usual activities. Conclusions Administration feasible these properties, while appeared problematic. severe also poorer HRQoL.

Language: Английский

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Trends and Patterns in Emergency Department Visits: A Comprehensive Analysis of Adult Data From the National Center for Health Statistics (NCHS) Database

Cureus, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 3, 2024

Background Emergency department (ED) visits among adults have increased in recent years, with the United States reporting 140 million ED 2021, equating to an overall rate of 43 per 100 people. This trend underscores challenges accessing primary care and addressing underlying health conditions. Understanding trends patterns utilization is essential for informing healthcare policy practice. Objective study aims comprehensively analyze using data from National Center Health Statistics (NCHS) database. Methods We conducted a retrospective analysis visit 1999 2019, focusing on aged 18 over. The prevalence rates were examined across demographic, socioeconomic, geographic groups datasets retrieved NCHS Statistical included one-way ANOVA chi-square tests assess variations rates. Results study's findings revealed consistent increase adults, 17.2 ± 0.3% 21.7 2019. Disparities evident demographic socioeconomic groups. Females had slightly higher rates, significant racial disparities noted, American Indian or Alaska Native Black African individuals showing highest Age-specific observed, young (18-24 years) older (65 years above) exhibiting Socioeconomic status insurance coverage emerged as determinants, highlighting access. Conclusion provides valuable insights into emphasizing need targeted interventions address improve access services.

Language: Английский

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Initial Development of a Patient Reported Experience Measure for Older Adults Attending the Emergency Department: Part I—Interviews with Service Users

Healthcare, Journal Year: 2023, Volume and Issue: 11(5), P. 717 - 717

Published: Feb. 28, 2023

Older adults are a major Emergency Department (ED) user group who may be especially vulnerable to the consequences of crowding and sub-optimal care. Patient experience is critical component high-quality ED care has previously been conceptualised using framework focusing on patients’ needs. This study aimed explore experiences older attending in relation existing needs-based framework. Semi-structured interviews were conducted during an emergency episode with 24 participants aged over 65 years United Kingdom annual census ~100,000. Questions exploring patient confirmed that meeting communication, care, waiting, physical, environmental needs prominent determinants for adults. A further analytical theme emerged which did not align framework, focused ‘team attitudes values’. builds knowledge relating ED. In addition, data will also contribute generation candidate items development reported measure

Language: Английский

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What is the impact of a pre-hospital geriatrician led telephone ‘Silver Triage’ for older people living with frailty?

European Geriatric Medicine, Journal Year: 2023, Volume and Issue: 14(5), P. 977 - 981

Published: May 23, 2023

Abstract Purpose Most older people are conveyed to hospital via ambulance, therefore presenting a focus reduce hospitalisation. North Central London has introduced ‘Silver Triage’, pre-hospital telephone support scheme where geriatricians the Ambulance Service with clinical decision-making. Methods Data from first 14 months was analysed descriptively. Results There have been 452 Silver Triage cases (November 2021 January 2023). 80% resulted in decision not convey. The mode frailty scale (CFS) 6. CFS did influence conveyance rates. Prior triage, paramedics thought hospitalisation required 44% of ( n = 72/165). All surveyed 176) would use service again. (66%, 108/164) felt they learnt something and 16% 27/164) reported it changed their decision-making process. Conclusion potential improve care by preventing unnecessary well received paramedics.

Language: Английский

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Geriatric Emergency Departments

Springer eBooks, Journal Year: 2024, Volume and Issue: unknown, P. 231 - 237

Published: Jan. 1, 2024

Language: Английский

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Comparing Emergency Nursing Measures Before and During COVID-19: A Retrospective Study of Assessment, Triage, and Workflow

SAGE Open Nursing, Journal Year: 2024, Volume and Issue: 10

Published: Jan. 1, 2024

Background The COVID-19 pandemic significantly impacted emergency department (ED) operations and patient care. Understanding its effects on nursing processes, triage accuracy, wait times is pivotal for optimizing outcomes. Objectives This study aimed to analyze the differences in before during pandemic. Design A retrospective cohort study. Methods analyzed 224 electronic medical records from a single ED, with 120 pre-pandemic period (January 2019–February 2020) 104 (March 2020–March 2021). Dependent variables included missed care per validated scales, accuracy Emergency Severity Index, physician examination. Independent factors encompassed sociodemographic, clinical characteristics, organization dynamics. Results Sociodemographic profiles were comparable between periods. Triage remained high except older patients. Nursing differed little, yet examination urgent case waits decreased amidst documentation completeness, such as recording status mental state, augmented this crisis period. Conclusion evaluation identified times, completeness at institution. Patient age influenced some metrics. Lessons comparing precrisis benchmarks intra-pandemic performance may guide preparedness strategies. Further research warranted optimize processes outcomes public health emergencies, well examine strategies through multicenter investigations prepandemic provide broader insights into challenges inform efforts bolster future crises.

Language: Английский

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Predicting the Impact of Mobile Field Hospital Deployment in Reducing Patients Mean Wait Times in Emergency Departments: An Agent-Based Simulation Approach

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 4, 2024

Mean wait time (MWT) in emergency departments refer to the average patients spend undergoing evaluation, or treatment at each stage, which can be significantly affected by sudden onsets of a disaster. Agent-based modeling (ABM) is computational technique that simulates interactions and behaviors individual agents defined environment enables study complex systems observing emergent outcomes agent-agent agent-environment interactions. This examines capability ABMs assessing impact response operations on hospital mean post-explosion scenario for an oil gas industry. The methodology this involves use agent-based modelling simulation tool (NetLogo 6.3.0) represent interaction within system rules, goals decision protocols. policy includes both traditional approach collaborative intervention through mobile field (MFH). dataset was generated, sampled analyzed using BehaviorSpace Pandas tools, respectively. results show strategic MFH resulted lower MWT, indicating higher effectiveness efficiency efforts. highlights need generate potential test how strategies might influence department times demonstrates techniques systems. could serve as important training health workers disaster managers preparedness.

Language: Английский

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