Evaluating a new emergency department avoidance service for older people: patient and relative experiences

פוסט זה זמין גם ב: עברית

Leanne Greene ,1 Rachel Lane,1 Maria Crotty,1 Craig Whitehead,1 Elizabeth Potter,1 Petra Bierer,2 Kate Laver

בעברית : אשפוז בית


Background High emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged 65 and above, the Southern Adelaide Local Health Network introduced an innovative ED avoidance service. This study assessed the acceptability of the service among its users.

Method The Complex And RestorativE (CARE) Centre is a six-bed unit staffed by a multidisciplinary geriatric team. Patients are transported directly to CARE after calling for an ambulance and being triaged by a paramedic. The evaluation took place between September 2021 and September 2022. Semi-structured interviews were conducted with patients and relatives who had accessed the service. Data analysis was performed using a six-step thematic analysis.

Results Seventeen patients and 15 relatives were interviewed, who described the experience of 32 attendances to the urgent CARE centre between them. Patients accessed the service for several reasons but over half were associated with falls. There was a hesitation to call emergency services for several reasons, the primary being long wait times in ED and/or the prospect of an overnight stay in hospital. Some individuals attempted to contact their General Practitioner (GP) for the presenting problem but were unable to get a timely appointment. Most participants had previously attended a local ED and had a negative experience. All individuals reported favouring the CARE centre over the traditional ED for numerous reasons including a quieter and safer environment and specially trained geriatric staff who were less rushed than ED staff. Several participants would have appreciated a standardised follow-up process after discharge.

Conclusion Our findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience.

2 תגובות

  1. Pinchas Halpern

    הנה דוגמה לרעיון לא טוב בעיניי: פתיחת “מלר”ד גריאטרי” חיצוני שמתהדרת בהורדת כמה חולים מהמלר”ד הכללי.
    אני חושב שיש הגיון בהפעלת שירות גריאטרי ופליאטיבי איכותי במלר”ד, אבל כחלק מהמלר”ד עצמו. נדרשות התאמות פיזיות מסויימות כמו גם תהליכיות כמובן, יש שאלה של הקצאת שטח ייעודי לעומת שימוש במיטות הכלליות, יש קושי בהשגת גריאטרים מומחים בכלל ושמוכנים לעבוד במלר”ד בפרט ועוד. אבל הניסיון שלנו באיכילוב עם גריאטר ייעודי היה טוב מאוד ואני ממליץ.

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