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THE GERIATRICEMERGENCY DEPARTMENT Yoram MaaraviJochanan Stessman2008 год

THE GERIATRIC EMERGENCY DEPARTMENT
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Аннотация: To the Editor: We read with great interest the paper by Hwang et al.1 and congratulate them on the detailed analysis of the challenges facing emergency departments (EDs) caring for older patients. We agree that a geriatric ED (GED) is an important service in every hospital caring for old people. We wish to inform the authors and the readers that a GED has been operating in the Hadassah-Hebrew University Medical Center in Mount Scopus, Jerusalem, for the past decade. The GED is a separate unit within the emergency medical services of the hospital that is open 24 hours a day 7 days a week and admits every patient aged 70 and older. Geriatricians, a resident, an attending physician, a geriatric nurse, and a social worker staff the department. Consultative services from all disciplines in the hospital are available, including physical, occupational, and speech therapy. Routine evaluation of all patients includes, in addition to medical history and physical examination, functional (activities of daily living (ADLs), instrumental ADLs) and cognitive (Mini-Mental State Examination) evaluations, fall risk assessment, depression (Geriatric Depression Scale), and social evaluation. The GED has direct access to continued care services, including acute and subacute care departments, home hospital, geriatric rehabilitation departments, skilled nursing departments, and a palliative care center, enabling patients to receive the optimal and most appropriate care that they deserve. To assess the contribution of the GED to the institution, 100 consecutive patients presenting to the GED at the Hadassah-Mount Scopus campus were compared with 100 consecutive patients presenting to the ED at the Hadassah-Ein Kerem campus (where no GED exists). All patients were aged 70 and older. Subjects were followed prospectively for 6 months post-ED discharge and a comparison of the two departments was performed for satisfaction with ED treatment, rate of independence in ADLs, and readmission rate. Results showed significantly higher satisfaction with ED treatment in the GED (P=.03), a higher rate of postdischarge independence in ADLs in the GED, although not statistically significant (15.9% vs 13.6%, P=.72), a significantly lower readmission rate in the GED (18% vs 30%, P=.047). We propose that the GED is designed to address the challenges of caring for older patients and may succeed in reducing disability and readmissions in this unique population. GED should be an integral part of every general hospital's emergency services. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contributions: Yoram Maaravi: concept and design, data analysis, and primary author. Jochanan Stessman: concept and design, criticism and suggested improvement of data analysis, and content of letter. Sponsor's Role: None.
Год издания: 2008
Авторы: Yoram Maaravi, Jochanan Stessman
Издательство: Wiley
Источник: Journal of the American Geriatrics Society
Ключевые слова: Emergency and Acute Care Studies, Intensive Care Unit Cognitive Disorders, Geriatric Care and Nursing Homes
Другие ссылки: Journal of the American Geriatrics Society (PDF)
Journal of the American Geriatrics Society (HTML)
PubMed (HTML)