老年专科护士评估及干预在急诊科的影响：一项系统综述
The impact of geriatric focused nurse assessment and intervention in the emergency department: A systematic review.
作者信息
Malik M, Moore Z, Patton D, O'Connor T, Nugent L E
机构信息
Emergency Department, St. James's Hospital, James's Street, Dublin 8, Ireland.
School of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; University of Ghent, Belgium.
出版信息
Int Emerg Nurs. 2018 Mar;37:52-60. doi: 10.1016/j.ienj.2018.01.008. Epub 2018 Feb 9.
BACKGROUND
Nursing assessment of elderly patients is imperative in Emergency Departments (ED) while providing interventions that increase independence facilitating discharge to primary healthcare.
AIMS
To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS).
METHODS
Search strategy used following databases; Cochrane, Medline, CINAHL, Embase, Scopus and Web of Knowledge; And terms; geriatric nurse assessment, nurse discharge planning, geriatric nurse specialist, nurse intervention, emergency department, accident and emergency, patient outcomes, discharge, admissions, readmissions, hospital utilization, hospitalization, length of stay/hospital stay.
RESULTS
Nine studies were included: seven RCTs and two prospective pre/post-intervention designed studies. Geriatric focused nursing assessment and interventions did not have a statistical impact on hospitalization, readmissions, LOHS and ED revisits. Risk screening and comprehensive geriatric assessment extending into primary care may reduce readmission rates but not affect hospitalization. An increase in ED visits in the intervention group at 30 days post-intervention was noted.
CONCLUSION
Inconsistencies in assessment and interventions for the older person in ED are apparent. Further research evaluating a standardised risk assessment tool and innovative interventions extending into primary healthcare is required.
背景
在急诊科对老年患者进行护理评估至关重要，同时要提供能增强其独立性的干预措施，以促进其转至初级医疗保健机构。
目的
系统评价急诊科以老年患者为重点的护士评估和干预措施对住院率、急诊科复诊率及住院时间的医院利用情况的影响。
方法
采用以下数据库的检索策略；Cochrane、Medline、CINAHL、Embase、Scopus和Web of Knowledge；以及检索词；老年护士评估、护士出院计划、老年护士专家、护士干预、急诊科、急症室、患者结局、出院、入院、再入院、医院利用、住院治疗、住院时间。
结果
纳入9项研究：7项随机对照试验和2项前瞻性干预前后设计研究。以老年患者为重点的护理评估和干预措施对住院治疗、再入院、住院时间和急诊科复诊率无统计学影响。风险筛查和延伸至初级保健的综合老年评估可能会降低再入院率，但不影响住院治疗。干预组在干预后30天的急诊科就诊次数有所增加。
结论
急诊科对老年人的评估和干预存在明显不一致。需要进一步研究评估标准化风险评估工具以及延伸至初级医疗保健的创新干预措施。
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