Sunday, 5 June 2016

Planting the SEED for a safe discharge from the emergency department

Demand for acute emergency care in Australia is steadily increasing and has risen as much as 32 per cent in the last decade. The fastest growth is seen in people aged over 65 years, and it’s accelerating beyond that accounted for by population ageing according to experts at SPHPM.

New findings from a ground-breaking Australian study conducted at the Alfred Hospital by Alfred Health and SPHPM has revealed that older patients have high rates of re-presentation to the Emergency Department (ED).

Senior Research Fellow Dr Judy Lowthian and colleagues conducted the Safe Elderly Emergency Department Discharge (SEED) study to determine factors associated with early return to ED.

“We aimed to identify the predictors of early and frequent re-presentation within 30 days of an ED visit in an older Australian population. This study is part of the Safe Elderly Emergency Discharge (SEED) project, which aims to develop a best practice model of care for older patients presenting to EDs,” Dr Lowthian said.

In the month following discharge, almost 15 per cent of the 959 patients re-presented. Of concern was that one in four patients in the study were assessed as cognitively impaired and more than a quarter of patients reported having depression or presenting with depressive symptoms at the time of presentation.

Cognitively impaired patients were at higher risk of re-presentation. “Cognitive impairment is a hidden co-morbidity affecting every stage of the patient’s management, from obtaining a history, consent for diagnostic testing and engagement in the treatment plan. This highlights a need for targeted interventions for patients with cognitive impairment that include seamless post-discharge support to help reduce return visits,” Dr Lowthian said.

The study also emphasised that a safe discharge plan involved communication with family, care givers and GP with 60 per cent of older patients reporting not understanding ED discharge information.

Other risk factors that emerged from the study included ED attendance in the previous year and lower triage category.

“We know that older patients have a high rate of unplanned early return to ED and this study in particular highlights the need for co-ordinated assessment of all older patients, with timely referral and linkage for post discharge care,” she said.

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