A Prospective Cohort Study of the Clinical and Process Outcomes of Older Adults That Transition Through the Geriatric Emergency Medicine Unit (GEM-U)
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 150
- 试验地点
- 1
- 主要终点
- Our primary outcome is incidence of hospital admission at index GEM-U presentation
研究概览
简要总结
This study will characterise the patients using the Geriatric Emergency Medicine Unit, a unit which provides specialist care for patients aged 75 years and older attending the emergency department. It will examine how this specialist care impacts their health in terms of a number of different outcomes, such as; function, quality of life and health care usage; for example admission to the acute hospital.
详细描述
The emergency department is a particularly challenging and busy environment, particularly for older adults living with frailty. It is widely acknowledged throughout the literature and national healthcare strategy that these older adults require holistic, person centred care that targets the intricacies of multifaceted, complex health issues.
The geriatric emergency medicine unit (GEM-U) aims to provide such care through the framework of comprehensive geriatric assessment, with in-put from a team of healthcare disciplines. The main aim of this study is to look at how this specialist care impacts patient outcomes, such as acute admission. Clinical and process outcomes of participants will be examined using patient reported outcome measures, which will include;
- Global measure of function (Barthel Index)
- Delirium screen (4AT +/- Delirium Rating Scale)*
- Frailty status (Clinical Frailty Scale)
- Nutritional status (Mini Nutritional Assesment)
- Quality of life (EuroQoL-5D-5L).
- Patient satisfaction (PSQ-18).
Participants will be followed at 30 days and 6 months post recruitment. All participants will give fully informed consent. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) standardised reporting guidelines will be followed in the conduct and reporting of this research. Data will be statistically analysed
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 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
- •Older adults aged ≥75 years
- •Manchester Triage System category 2-5
- •Screen positive for risk of adverse outcomes after ED visit (≥ 2 on ISAR screening tool)
- •Presenting with a medical condition
- •Reviewed by the Older Persons Integrated Care Team
排除标准
- •Patients presenting with a non-medical issue including major trauma or hip fracture
- •Patients presenting with acute stroke or transient ischaemic attack
- •Patients more appropriate to another alternative pathway e.g. deep vein thrombosis pathway, low risk chest pain pathway
- •Patients with acute coronary syndrome or unstable arrthymia
- •Patients requiring care in the resuscitation room
- •Patients with head injury (unless appropriate assessment and management has been fully completed by ED team)
- •Patients with possible spinal injury (unless appropriate assessment and management has been fully completed by ED/orthopaedic team)
- •Patients with low Glasgow Coma Scale
- •Other exclusions at the discretion of the Older Persons Integrated Care team depending on team capacity and expertise
- •Exclusion criteria as set out above, are in line with those set out in the UHL Operating Policy of the Older Persons Integrated Care Team.
结局指标
主要结局
Our primary outcome is incidence of hospital admission at index GEM-U presentation
时间窗: Patients are followed at 30 days and 6 months
Patients who attend GEM-U and have an acute hospital admission at this time
次要结局
- Unscheduled ED revisit(Patients are followed at 30 days and 6 months)
- Mortality(Patients are followed at 30 days and 6 months)
- Unscheduled hospital visit(s)(Patients are followed at 30 days and 6 months)
- Nursing home admission(Patients are followed at 30 days and 6 months)
- Healthcare utilization (GP visit, out-patient geriatric services, PHN visit, HSCP services)(Patients are followed at 30 days and 6 months)