French multicenter evaluation of the appropriateness of admission to the emergency department of the over-80s

Menand, Emily; Lenain, Émilie; Lazarovici, C.; Châtellier, Gilles; Saint-Jean, Olivier; Somme, Dominique; Corvol, Aline

doi:10.1007/s12603-015-0489-9

Cited by 13 publications

(16 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Totally, 14 (6%) out of 248 admissions under investigation did not have appropriate conditions and were determined as inappropriate admissions. Some studies carried out in this field using AEP assessed the rates of inappropriate admissions as 7% -8.5% (1,8,9,13,(16)(17)(18)(19), which are somehow similar to the results of the current study. In another study by Soria-Aledo et al to estimate inappropriate admissions employing AEP, this rate was equal to 7.4% (1).…”

Section: Discussionsupporting

confidence: 84%

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

et al. 2019

View full text Add to dashboard Cite

Background: Appropriate allocation of resources is an important issue in the delivery of services that can reduce the health system costs. The inappropriateness of healthcare services is one of the problems that increase the pressure on hospitals and patients. Methods: In this study, the data were collected using the appropriateness evaluation protocol by a medicine specialist at Rasoul Akram Hospital. In total, 248 participants were selected through systematic sampling. To calculate the financial burden simultaneously with the evaluation of inappropriate hospitalization days, the medicine and facility costs along with the cost of bed-day were estimated. Data were analyzed by SPSS software. Results: The type of treatment was surgery in 56.8% of the patients and 43.2% of them were admitted to the hospital for internal medicine. The mean length of stay was 4 ± 6 days. The inappropriate admission rate was estimated at about 6% and the rate of inappropriate hospital stays was 21.5%. The most important factors influencing the inappropriateness of hospitalization were delayed medical consultations, delayed surgery, conservative practitioner, and the follow-up of clinical test results. The sum of the direct financial burden of inappropriate hospitalization for the patients was estimated at around 1060 dollars. Conclusions: The findings of this study indicated that inappropriate hospitalization and admission imposed a huge financial burden on the health system and community. Hospital authorities by considering issues such as delayed medical consultations and delayed surgery can decrease the financial burden of inappropriate hospitalization to a large extent.

show abstract

Section: Discussionsupporting

confidence: 84%

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Across all studies 4 to 55% of ED transfers were classified as inappropriate [2, 3, 5, 18, 27, 29, 30, 32, 35, 39–46]. The definition of inappropriateness varied widely between studies (see Additional file 2: Table S3).…”

Section: Resultsmentioning

confidence: 99%

“…Some authors defined inappropriate ED transfers as preventable transfers; a transfer that may have been avoided if an existing condition would have been managed optimally in the NH at an earlier stage or when adequate prevention would have avoided its initial presentation [2, 27, 29, 45, 47]. Other authors defined inappropriateness by using a list of symptoms and conditions that were frequently associated with potentially preventable ED visits and hospitalisations [18, 27, 29, 31, 33, 44–46, 48]. On the other hand, some authors defined appropriate ED admissions using a list of symptoms and conditions certainly needing acute medical attention [5, 18, 45, 46].…”

Section: Resultsmentioning

confidence: 99%

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

et al. 2019

View full text Add to dashboard Cite

BackgroundElderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.MethodsSystematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract.ResultsSeventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital.ConclusionsThe definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.

show abstract

“…At least 4 studies referred to the cost of inappropriate admissions for specific health conditions of surgical procedures …”

Section: Resultsmentioning

confidence: 99%

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

219

205

View full text Add to dashboard Cite

BackgroundThe impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized.AimTo systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs.MethodsFour of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.ResultsThirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.ConclusionsThe poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.

show abstract

French multicenter evaluation of the appropriateness of admission to the emergency department of the over-80s

Abstract: Inappropriate emergency admissions of older patients were infrequent. None of the geriatric syndromes were linked with the phenomenon and principle causes were severity of illness, mention of a cardiac disease, unclear pattern of consultation and institutionalized way of life.

Cited by 13 publications

References 33 publications

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

Appropriateness of transferring nursing home residents to emergency departments: a systematic review

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Contact Info

Product

Resources

About