Tools Development for Geriatric Emergency Regulation at the Emergency Service Centre, in the Rhône Area
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 2,279
- 试验地点
- 1
- 主要终点
- Proportion of patients sent to an emergency department
研究概览
简要总结
According to surveys, 13% to 20% of the Service Médical d'Urgence (SAMU) centre 15 (French 911) calls concern elderly patients above 75 years of age. For these patients, the clinical pathway should be decided on the basis of the symptomatology described during the call, but also with the gathering of specific data such as medical social and psychological evaluation. These items allow the regulating doctor to assess comorbidity, on-going treatment, psycho-cognitive status, previous hospitalisations, social situation, and patient expectations and needs.
However, data collected in order to assess the situation on the phone and take the orientation decision are mainly limited to the severity of clinical symptoms. Medical, psychological and social aspects are rarely gathered, for several reasons :
- Phone call shortness : emergency calls should be treated quickly
- Regulating doctors are not trained to take in account the specificities or geriatric patients in their decision making. Besides, they are not informed about alternatives to the hospital emergency department, such as "geriatric channel" system.
An observational study was performed in 2012 on 692 calls about elderly patients referred to the SAMU centre 15 during 7 days : 63% of these patients were transferred to an emergency department. Regardless of severe cases "hospital regulation", 55% of the least serious cases ("liberal regulation") were transferred to an emergency department.
Regulation is inadequate to elderly patients for whom 1) the situation assessment and the appropriate decision making require specific items that are not known by regulating doctors, 2) the medical care and the clinical pathway could be improved by the knowledge of on-field "geriatric channel", 3) the emergency department care is particularly long, 4) and could be pernicious to younger patients.
1920 patients will be recruited between January 2016 and August 2017, including a 6 months wash-out in order to train regulating doctors. This training will include geriatric patient's specificities, and geriatric channels. A 12% difference between the 2 groups (before and after the training) is expected, considering a 80% statistical power. The design is a time series experiment.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 75 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient above 75 years olds
- •Patient calling for a liberal regulation
- •Patient calling between 8 a.m. and 6 p.m. from monday to friday
排除标准
- •Patient calling for vital emergency (hospital regulation)
- •Patient calling for inter-hospital transport
结局指标
主要结局
Proportion of patients sent to an emergency department
时间窗: 24 hours after patient's call
The training course efficiency (which contains specific regulation tools and emergency regulation doctors formation) will be assessed by evaluating the proportion of 75 years old patients and older sent to an emergency department after a liberal regulation.
次要结局
- Non medical cost for patient(7 days after patient's call)
- Duration of the hospital stay in emergency department(7 days after patient's call)
- Occurence of non-programmed hospitalization in emergency department(7 days after patient's call)
- Geriatric channel utilisation rate(24 hours after patient's call)
- Training course cost(7 days after patient's call)
- Training course feasibility(24 hours after patient's call)
- Medical cost for patient(7 days after patient's call)