Predictors of emergency department referral in patients using out-of-hours primary care services

Scapinello, Maria Paola; Posocco, Andrea; Ronch, Irene De; Castrogiovanni, Francesco; Lollo, Gianluca; Sergi, Guglielmo; Tomaselli, Iginio; Tonon, Loris; Solmi, Marco; Traversa, Stefano; Zambianco, Vincenzo; Veronese, Nicola

doi:10.1016/j.healthpol.2016.07.018

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…Women, in fact, were admitted to nursing homes more frequently, but were also re-hospitalized less frequently than men. It is possible that women admitted to a nursing home received better care, hence reduced risk of re-hospitalization, than men returning at their home [34]. The higher social isolation of women, living more frequently alone before hospitalization, might also explain their more frequent admission to a nursing home after discharge.…”

Section: Discussionmentioning

confidence: 99%

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

et al. 2019

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The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. Study design: We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. Main outcome measures: People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and cohabitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. Results: Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge. Conclusion: Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of rehospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.

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Section: Discussionmentioning

confidence: 99%

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

et al. 2019

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“…Extant published literature in the field provides an insight into how the higher likelihood of the inappropriate and frequent utilisation of unnecessary ambulance services can be demographically predicted. Patterns of this are characterised by an incidence of lower socioeconomic status, chronic disease status and low perceptions of healthcare accessibility in practice (Hudon, Sanche and Haggerty, 2016;Scapinello, 2016). Within this literature there is, notably, minimal mention of the accountability of the independent care sector workforce in requesting emergency services and the situational contexts in which this may happen, but which may subsequently be attributed to people in these groups.…”

Section: Introductionmentioning

confidence: 99%

Falls: nine things to consider before dialling 999

Hayes

Scott-Thomas²,

Mains

et al. 2019

Nursing and Residential Care

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“…The extant literature provides an insight into how the higher likelihood of the inappropriate and frequent utilisation of unnecessary ambulance services can be demographically predicted. Patterns of this are characterised by an incidence of lower socioeconomic status, chronic disease status and low perceptions of healthcare accessibility in practice (Hudon, Sanche and Haggerty, 2016;Scapinello, 2016). Within this literature there is, notably, minimal mention of the accountability of the independent care sector workforce in requesting emergency services and the situational contexts in which this may happen, but which may subsequently be attributed to people in these groups.…”

Section: Introductionmentioning

confidence: 99%

Norms of staff responses to falls in residential care

Scott-Thomas¹,

Graham²,

Ling³

et al. 2017

Journal of Paramedic Practice

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Aim: To review the first line response to patient falls that is operational in the independent care sector in a specific geographical region of North East England. Design: Questionnaire survey implemented online via 'Survey Monkey' software package. Sample: A convenience sample of 24 of 32 independent care sector homes from South Tyneside, UK participated in the study, representing a 75% response rate. Results: Policies and guidelines for falls in the independent care sector homes were investigated, as understood by care home managers. The findings highlight the disparate responses to falls in the care home settings. Despite 96% of homes having a policy on falls, only 80% of these included an assessment of possible injury or harm to residents and 13% included no direct guidance for care staff in instances where residents fall and are on the floor. For those policies that did include direct guidance, there was a great disparity in available information, especially between domiciliary and residential care home settings. The most common recommended action was to ring emergency services in order to move patients, even in the absence of evidence of physical injury. In the context of residential care home settings there was a high degree of ambiguity around the assessment of sustained injuries and whose responsibility this was. This was particularly evident in relation to falls where potentially non-visible injuries which were subsequently not immediately identifiable. There was also reported ambiguity in relation to the management of falls, where there was overlap between accident policies and falls policies. Conclusions: Our research highlights the need for standardisation of policies and procedures in relation to falls of those living under the care of the independent care sector. At present, there is a disparate set of approaches evident in the contexts of care, which are largely determined by locally devised and implemented policies, which prioritise legalistic and bureaucratic concerns over clinical decision making. Our study highlights the potential fiscal impact on emergency ambulance services in instances where it is commonplace for contacting emergency services to be the first line response to a patient falling to the floor regardless of whether an injury has occurred. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation This has important implications for the education of independent care sector workers and the strategic planning of emergency ambulance services. Whilst generic frameworks are available, further consideration of the whether falls policies are suited for purpose is urgently required.

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Predictors of emergency department referral in patients using out-of-hours primary care services

Cited by 7 publications

References 23 publications

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

Falls: nine things to consider before dialling 999

Norms of staff responses to falls in residential care

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