Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

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Geriatrische revalidatiezorg na triage op de Spoedeisende Hulp: Patiëntkarakteristieken en revalidatie-uitkomsten

Tijdschrift voor Gerontologie en Geriatrie ◽

10.36613/tgg.1875-6832/2019.01.02 ◽

2019 ◽

Keyword(s):

Emergency Department ◽

Residential Care ◽

Functional Decline ◽

Care Facility ◽

Geriatric Rehabilitation ◽

Residential Care Facility ◽

Successful Group ◽

Geriatrische Revalidatiezorg ◽

One Year ◽

Single Contact

In the Netherlands geriatric rehabilitation is possible (among others) for patients who are selected by a geriatrician at the emergency department of a hospital. The aim of this study was to investigate the rehabilitation trajectory of patients who were selected for geriatric rehabilitation at the emergency department after a single contact with the geriatrician and to identify patient factors related to rehabilitation outcome. Successful rehabilitation was defined as discharge to home or a residential care facility after a maximum of 6 months. All patients who in 2016 were selected for geriatric rehabilitation were included. Data were collected retrospectively from electronic patient files. 74 patients were included (mean age 84.7 years). 84% were successfully discharged home or to a residential care facility within six months. The presentation with a fall and the absence of a partner at home was higher in the unsuccessful group. In the successful group more patients lived independent and without professional help prior to rehabilitation. Noteworthy is that the analysed patient group is a frail group, considering the high one-year mortality (21,6%) and overall functional decline despite geriatric rehabilitation.

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P151: Occupational therapy in the emergency department: sustaining results

CJEM ◽

10.1017/cem.2018.349 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S110-S111

Author(s):

J. Trenholm

Keyword(s):

Emergency Department ◽

Occupational Therapy ◽

Hospital Admissions ◽

Discharge Planning ◽

Functional Decline ◽

Pilot Project ◽

Added Value ◽

Functional Impairments ◽

Chart Audit ◽

Number Of Patients

Introduction: An emergency department visit may represent a sentinel event for someone who is older and frail, signalling a slide into dependence and functional decline. The gold standard for the treatment of frail older adults is a comprehensive geriatric assessment, involving consideration of multiple domains including mobility and function in activities of daily living. Despite this, when a chart audit was conducted in a Canadian metropolitan emergency department, none of the patients age 65 and older had a documented assessment of their function or mobility. In response, an occupational therapy program was implemented. The goals of this program were to reduce the number of unnecessary hospital admissions related to patient functional impairments, and to increase function, safety, and independence for patients upon discharge from the emergency department. Methods: The pilot project, which was completed in 2013, was evaluated using a mixed methods approach. Positive patient outcomes at that time included a reduction in avoidable admissions and better support for patients upon discharge from the emergency department. A survey of emergency department staff indicated that occupational therapy consultation added value to the diagnostic and discharge planning processes. However, due to changes in administrative priorities, several service redesigns were required. Multiple PDSA cycles were completed, and the development of a logic model guided and focused program development. Results: A reassessment of program objectives was conducted using 2015 data, which found that the number of patients seen by the occupational therapist remained the same, as did the percentage of patients discharged with support of occupational therapy intervention, such as provision of adaptive equipment or referral to community rehabilitation referrals. The percentage of patients discharged due to occupational therapy as a primary contributing factor rose slightly, and staff satisfaction with the program remained high. Conclusion: This evaluation proves that the provision of occupational therapy services in the emergency department is sustainable, benefits patients, and can be incorporated into the emergency department workflow and culture.

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P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽

10.1017/cem.2016.259 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S106-S106

Author(s):

E. Losier ◽

A. McCollum ◽

P. Jarrett ◽

R. McCloskey ◽

P. Nicholson ◽

...

Keyword(s):

Emergency Department ◽

Assisted Living ◽

Demographic Data ◽

Care Home ◽

Functional Decline ◽

Retrospective Chart Review ◽

Community Services ◽

Level 3 ◽

Ed Visits ◽

One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

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