In-reach nursing services improve older patient outcomes and access to emergency care

Street, Maryann; Considine, Julie; Livingston, Patricia M.; Ottmann, Goetz; Kent, Bridie

doi:10.1111/ajag.12137

Cited by 25 publications

(45 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The hospital admission rate in the present study was 87.2%, slightly higher than the 75% reported in the single-site pilot study 2 and much higher than the admission rates reported in Australian studies of transfers from residential aged care facilities to acute care, which range from 45.5% to 68.6%. 17,18 In the present study, the in-hospital mortality rate was 15.4% and similar to the 14.7% in-hospital mortality rate reported in the pilot study. 2 It may be argued that high mortality rates are expected in a cohort of older patients with comorbidities; however, data from other sources show much lower mortality rates in older hospital patients.…”

Section: Discussionsupporting

confidence: 89%

Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Considine¹,

Street²,

Botti³

et al. 2015

Aust. Health Review

Self Cite

View full text Add to dashboard Cite

Objective. The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care.Methods. Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of subacute care admission.Results. In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of subacute care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01).Conclusions. There is a high rate of unplanned transfers to acute care within 24 h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates.What is known about the topic? Subacute care is becoming a high acuity environment where many patients are at significant risk of clinical deterioration. Systems for recognising and responding to deteriorating patients are well developed in acute care, but still developing in subacute care. What does this paper add? This is the first Australian multisite study of clinical deterioration in patients situated in subacute care facilities. One-third of unplanned transfers occur within 24 h of admission to subacute care. Patients who require unplanned transfer from subacute to acute care have unexpectedly high hospital admission rates and high in-hospital mortality rates. The frequency and completeness of physiological monitoring preceding transfer was low. What are the implications for practitioners? Patients in subacute care require regular physiological assessment and early escalation of care if there are physiological abnormalities. Risk of clinical deterioration should be a factor in the decision to admit patients to subacute care after an acute illness or injury. There is a need to improve systems for recognising and responding to deteriorating patients in subacute care settings.

show abstract

Section: Discussionsupporting

confidence: 89%

Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Considine¹,

Street²,

Botti³

et al. 2015

Aust. Health Review

Self Cite

View full text Add to dashboard Cite

show abstract

“…For example, exclusion of non‐English literature and studies describing services such as observation or short stay units that operate similarly to MAUs that did not comply with the IMSANZ standards. Some of these articles included topics relevant to the two main foci of this review (older people and MAUs) such as techniques in risk assessment, nursing models of care, diagnostic pathways for complex patients, cognitive screening for older people and the use of funnel plots to improve efficiency and reduce patient mortality .…”

Section: Discussionmentioning

confidence: 99%

Scoping review of medical assessment units and older people with complex health needs

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Although the experiences of other countries have found positive results with the implementation of practices by nurses, it should be pointed out that they are linked to a multidisciplinary approach and, for the most part, are inserted into care models and welfare programs geared toward the elderly (5,16,18) . Another question that did not reach consensus was related to the need of a specialized interdisciplinary team in gerontology/geriatrics to support cases of high-risk and fragile elderly people.…”

Section: 6mentioning

confidence: 99%

“…The experiences described by care programs have demonstrated that, through appropriate geriatric assessments, identification of risks, and support strategies in the transition of the care, it is possible to reduce the return of the elderly to the ES, avoid admissions, obtain greater satisfaction, and reduce hospital costs (5,16,(18)(19) . Therefore, these studies offer different examples that can encourage new practices in the ES together with the reality of each institution.…”

Section: 6mentioning

confidence: 99%

Elder-friendly emergency services in Brazil: necessary conditions for care

Santos

Lima

Zucatti

2016

Rev. esc. enferm. USP

View full text Add to dashboard Cite

Objective:To identify and analyze the aspects necessary to provide an elder-friendly emergency service (ES) from the perspective of nurses. Method: This is a descriptive, quantitative study using the Delphi technique in three rounds. Nurses with professional experience in the ES and/or researchers with publications and/or conducting research in the study area were selected. The first round of the Delphi panel had 72 participants, the second 49, and the third 44. An online questionnaire was used based on a review of the scientific literature with questions organized into the central dimensions of elder-friendly hospitals. A five-point Likert scale was used for each question and a 70% consensus level was established. Results: There were 38 aspects identified as necessary for elderly care that were organized into central dimensions. Conclusions: The study's results are consistent with the findings in scientific literature and suggest indicators for quality of care and training for an elder-friendly ES. DESCRIPTORSAged; Health of the Elderly; Emergency Nursing; Geriatric Nursing; Emergency Service, Hospital.Elder-friendly emergency services in Brazil: necessary conditions for care* Serviços de emergência amigos do idoso no Brasil: condições necessárias para o cuidado Servicios de urgencias amigos del anciano en Brasil: condiciones necesarias para el cuidado

show abstract

In-reach nursing services improve older patient outcomes and access to emergency care

Abstract: There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

Cited by 25 publications

References 25 publications

Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care

Scoping review of medical assessment units and older people with complex health needs

Elder-friendly emergency services in Brazil: necessary conditions for care

Contact Info

Product

Resources

About