QUESTION UNDER STUDY: Elderly patients represent an increasing proportion of emergency department (ED) admissions. When no specific complaint is identified, the reason for referral is commonly called "home care impossible". The aim of this study was to describe a population of elderly patients who present to the ED of a 1200-bed university hospital without specific complaint, and to assess how they were evaluated in the ED. METHODS: Data on triage, mode of admission and discharge were collected. After the initial evaluation in the ED, patients were classified in two categories: (1) patients identified with a medical problem requiring rapid care or investigation, (2) patients without a medical problem considered as true "home care impossible". These latter patients underwent a complete assessment using the Minimal Data Set-Home Care (MDS-HC). RESULTS: During the 10-week study period 253 patients (mean age 81 years) were referred because of "home care impossible". An acute medical problem was identified in 129 of those patients (51%). All these patients were triaged in lower acuity categories. 33 (26%) were undertriaged due to (1) absence of vital signs measurement, (2) poor recognition of neurological symptoms, (3) atypical clinical presentation. The remaining patients were considered as true "home care impossible". The MDS-HC evaluation revealed a high level of biopsychosocial comorbidities. CONCLUSIONS: Frail elderly patients admitted without specific complaints are at risk of inappropriate or delayed evaluation due to undertriage at the door of the ED. A more specific geriatric assessment should be integrated early in the triage process of these patients.
QUESTION UNDER STUDY: Elderly patients represent an increasing proportion of emergency department (ED) admissions. When no specific complaint is identified, the reason for referral is commonly called "home care impossible". The aim of this study was to describe a population of elderly patients who present to the ED of a 1200-bed university hospital without specific complaint, and to assess how they were evaluated in the ED. METHODS: Data on triage, mode of admission and discharge were collected. After the initial evaluation in the ED, patients were classified in two categories: (1) patients identified with a medical problem requiring rapid care or investigation, (2) patients without a medical problem considered as true "home care impossible". These latter patients underwent a complete assessment using the Minimal Data Set-Home Care (MDS-HC). RESULTS: During the 10-week study period 253 patients (mean age 81 years) were referred because of "home care impossible". An acute medical problem was identified in 129 of those patients (51%). All these patients were triaged in lower acuity categories. 33 (26%) were undertriaged due to (1) absence of vital signs measurement, (2) poor recognition of neurological symptoms, (3) atypical clinical presentation. The remaining patients were considered as true "home care impossible". The MDS-HC evaluation revealed a high level of biopsychosocial comorbidities. CONCLUSIONS: Frail elderly patients admitted without specific complaints are at risk of inappropriate or delayed evaluation due to undertriage at the door of the ED. A more specific geriatric assessment should be integrated early in the triage process of these patients.
Authors: Christopher R Carpenter; Kennon Heard; Scott Wilber; Adit A Ginde; Kirk Stiffler; Lowell W Gerson; Neal S Wenger; Douglas K Miller Journal: Acad Emerg Med Date: 2011-06 Impact factor: 3.451
Authors: Julia Karakoumis; Christian H Nickel; Mark Kirsch; Martin Rohacek; Nicolas Geigy; Beat Müller; Selina Ackermann; Roland Bingisser Journal: Medicine (Baltimore) Date: 2015-07 Impact factor: 1.889
Authors: Christian H Nickel; Juliane M Ruedinger; Anna S Messmer; Silke Maile; Arno Peng; Michael Bodmer; Reto W Kressig; Stephan Kraehenbuehl; Roland Bingisser Journal: Scand J Trauma Resusc Emerg Med Date: 2013-03-05 Impact factor: 2.953
Authors: Franziska Matzer; Ursula V Wisiak; Monika Graninger; Wolfgang Söllner; Hans Peter Stilling; Monika Glawischnig-Goschnik; Andreas Lueger; Christian Fazekas Journal: PLoS One Date: 2012-08-28 Impact factor: 3.240