Correlation between two instruments screening frail elderly patients living at home and hospitalized through the emergency department

Purpose In a novel approach, two part-time “Link Nurses” within an NE Hampshire practice of 16,500 patients were funded by a local charity, to assess and manage unmet needs of isolated frail elderly patients at home. The paper aims to discuss these issues. Design/methodology/approach Patients in this vulnerable group with no recorded healthcare contact for a prolonged period were identified from practice computer records. One group was to be assessed at home, and appropriate interventions effected. Follow-up visits or telephone contacts also offered support to carers as well as isolated individuals. A matching quasi control group was identified but not visited, to assess the overall impact on the patients, GP and other healthcare contacts. Difficulties with the control group were encountered and addressed. Findings Important unmet healthcare needs were found amongst the visited patients, which the nurses were able to address themselves, or refer to the GPs or appropriate agencies. The control group demonstrated greater demand for out-of-hours, GP and district nurse contacts, and more unplanned hospital admissions. Practical implications Besides dealing with unmet needs at home, ongoing support by local GP nurses may reduce bed-blocking by moving away from “crisis management” of patients in this vulnerable group. Originality/value Few other trials have employed practice nurses to see and manage frail elderly patients in their homes.

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Preventing emergency department visits and hospitalizations for asthma by use of oral corticosteroids at home: Are we adhering to national guidelines?

Journal of Asthma ◽

10.1080/02770903.2010.514641 ◽

2010 ◽

pp. 100913044943042-5

Author(s):

Timothy H. Self ◽

Cary R. Chrisman ◽

Anna R. Jacobs ◽

Ngan H. Vo ◽

John C. Winton

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

National Guidelines ◽

Oral Corticosteroids ◽

At Home

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Evaluation of the sysmex UF-5000 fluorescence flow cytometer as a screening platform for ruling out urinary tract infections in elderly patients presenting at the Emergency Department

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365513.2021.1929441 ◽

2021 ◽

pp. 1-6

Author(s):

Lasse Krogh Alenkaer ◽

Lise Pedersen ◽

Pal Bela Szecsi ◽

Poul Jannik Bjerrum

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Elderly Patients ◽

Urinary Tract Infections ◽

Flow Cytometer ◽

Screening Platform ◽

Tract Infections

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Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

The Ultrasound Journal ◽

10.1186/s13089-021-00230-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Luigi Vetrugno ◽

Enrico Boero ◽

Elena Bignami ◽

Andrea Cortegiani ◽

Santi Maurizio Raineri ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Observational Study ◽

Elderly Patients ◽

Fracture Fixation ◽

Frail Elderly ◽

Statistical Power ◽

Lung Ultrasound ◽

Preoperative Evaluation ◽

Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

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