Impact of Geriatric Hotlines on Health Care Pathways and Health Status in Patients Aged 75 Years and Older: Protocol for a French Multicenter Observational Study

Abstract

Background In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France’s regional health authorities proposed creating direct telephone helplines, “geriatric hotlines,” staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly. Objective This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline. Methods The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline. Results The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020. Conclusions The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications—geriatric syndromes—and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path. Trial Registration ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475 International Registered Report Identifier (IRRID) DERR1-10.2196/15423

Risk indices that predict in-hospital mortality of elderly patients

“…In the elderly population, adverse outcomes are predominantly associated with major surgery [20][21][22]. However, we note that, in the elderly population, medical consultations were requested more frequently than surgical consultations (1339 vs. 1040), although this difference did not reach statistical significance [23] also emphasized that shorter LOHS will reduce various complications such as geriatric syndrome and the subsequent domino effect. In addition, they emphasized that improving the quality of healthcare for the elderly, particularly organization of transportation services, may provide better outcomes.…”

Impact of a Very Short-Stay Post-Emergency Geriatric Unit on Early Readmissions

“…This shows the need to develop an effective relationship between hospitals and nursing homes, which could involve the intervention of multidisciplinary community-based geriatric mobile teams. 12 Patients with infections, a main cause of hospitalization in the UTAG, rapidly returned home without early readmissions. This type of care, which can be continued at home, is suitable for UTAG and can be retained as a good indication for its use: to initiate intravenous antibiotic treatment before oral switch and to allow setting up the home care needed to secure a return home with the appropriate professionals and eventual physiotherapist.…”

Covid-19: Adapting the geriatric organisations to respond to the pandemic

“…In the city of Saint-Etienne and its metropolitan area, there are around forty nursing homes. Before the Covid-19 epidemic, the University Hospital of Saint-Etienne proposed hotline designed to enhance general practitioner (GP) clinic-hospital interactions by phone [9]. This system has shown a positive effect on the number of emergency department visits, whose deleterious effects are described in the literature and provide support to GPs in caring for older adults.…”

“…In older adults, without a clear respiratory presentation, the symptoms listed above should make one think about Covid-19. Elderly patients then find themselves exposed to new infectious history in a context of major frailty that can lead to decompensation linked to the geriatric syndromes [9]. In this context, it is therefore fundamental to consider not only Covid-19 infection management but also global geriatric care lessening the risk of this cascading decompensation [10].…”