ICEECE2012 Nurses Abstracts (1) (28 abstracts)
Interdisciplinary risk assessment and patient discharge management: combining biomarker & clinical scores, medical & nursing aspects
Antoinette Conca 1 , Ursula Schild 1 , Katharina Regez 1 , Rita Bossart 1 , Petra Tobias 1 , Gabriela Wallimann 1 , Ruth Schweingruber 1 , Barbara Reutlinger 1 , Werner Albrich 2 , Kristina Rüegger 2 , Frank Dusemund 2 , Philipp Schütz 2 , Andreas Huber 3 , Ulrich Bürgi 4 & Beat Müller 2
1Nursing Department, Kantonsspital Aarau, CH-5001 Aarau, Switzerland; 2Medical University Department, Kantonsspital Aarau, CH-5001 Aarau, Switzerland; 3Department of Laboratory Medicine, Kantonsspital Aarau, CH-5001 Aarau, Switzerland; 4Emergency Department, Kantonsspital Aarau, CH-5001 Aarau, Switzerland.
Introduction: Current medical and nursing scores have limited efficiency and safety profiles to assign the most appropriate treatment site to patients with lower respiratory tract infections (LRTIs). We assessed the potential of a combined score of CURB65 with proadrenomedullin (ProADM) levels and the adapted post-acute discharge score (PACD) for triage and discharge management decisions. We aimed to identify the proportions of patients who would be best cared for at different levels of care ranging from home with or without home-health care (Spitex), health ressort, nurse-led unit (NLU), and rehabilitation to acute-care hospitals.
Methods: Consecutive patients with LRTIs presenting to our emergency department were prospectively followed and retrospectively classified according to CURB65 and ProADM levels (CURB65-A) and biopsychosocial risk (PACD). We compared proportions of patients virtually allocated to triage sites with actual triage decisions and assessed the added impact of ProADM and the accuracy of the PACD.
Results: Overall, 93% of 146 patients were hospitalised. Among the 138 patients with available CURB65-A, 17.4% had a low medical risk indicating possible treatment in an outpatient or non-acute medical setting; 34.1% had an intermediate medical risk (short-hospitalisation); and 48.6% had a high medical risk (hospitalisation). Reasons for staying in the acute care setting after resolving medical problems (mean 3.6 days) were predominantly organisational (e.g. waiting for a post-acute care facility, 43 (69%) of the 62 nursing overruling reasons). The PACD identified in 55% (n=202) of the LRTI patients a risk for post-acute care needs (sensitivity 82%; specificity 55%).
Conclusion: Current rates of hospitalization are high in patients with LRTI and length of stay frequently extended beyond time of medical stabilization. This suggests a substantial potential of an interdisciplinary and biomarker-enhanced triage. The PACD was able to predict post-acute care needs and qualifies for screening purposes to facilitate early interdisciplinary discharge management.
Keywords: interdisciplinary risk assessment, post-acute care needs, triage, discharge management.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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