PDF(Pubmed)
Abstract：
Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital.
This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of \'hospital letters\': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders.
In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91).
The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP\'s. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.
This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of \'hospital letters\': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders.
In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91).
The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP\'s. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.
摘要：
背景：虚弱的老年患者入院时面临许多并发症的风险。制定有关虚弱的老年患者信息传递的指南的多学科区域透壁协议（RTA）可能会改善预后。我们的目的是调查RTA的实施对虚弱的老年患者入院和出院时信息传递完整性的影响。
方法：这是一项回顾性队列研究，在实施RTA之前，我们从400名随机选择的住院虚弱的老年患者（70岁以上）中收集了数据，2021年1月至3月及之后，2021年10月至12月。这群人分为四组，决定了要检查哪些信件(全科医生(GP)的推荐信和三组“医院信件”:入院时的ED信，给老年护理医生的临床出院信和给全科医生的临床出院信。我们评估了脆弱的提法，药物清单和复苏命令的提及。
结果：在实施之前，患者的平均年龄为82.6岁（SD7.4），女性为101（50.5%），实施后平均年龄为82.3岁(SD6.9),女性为112岁(56.0%).实施前在医院信函中提到虚弱的比例为12.7%，实施后为15.3%(p=0.09)。实施后出现了更多的GP推荐信(32.0%vs.54.0%,p=0.03),然而，仅在之前的12.5％和之后的7.4％中提到了脆弱（p=0.58）。医院的用药清单交接情况良好(此前为89.3%,94%后，p=0.20)，甚至更好的来自GP(之前为93.8%，100%之后,p=0.19）。实施前59.3%的医院信件中提到了复苏令，实施后57.3%(p=0.77)，高于推荐信(前18.8%，后22.2%(p=0.91)。
结论：RTA的实施提高了GP推荐信的数量；然而，这并没有导致医院和全科医生之间的其他沟通显着改善。报告中仍然经常没有提到虚弱和复苏命令。在成功实施后，可以调查结局的改善情况.
方法：这是一项回顾性队列研究，在实施RTA之前，我们从400名随机选择的住院虚弱的老年患者（70岁以上）中收集了数据，2021年1月至3月及之后，2021年10月至12月。这群人分为四组，决定了要检查哪些信件(全科医生(GP)的推荐信和三组“医院信件”:入院时的ED信，给老年护理医生的临床出院信和给全科医生的临床出院信。我们评估了脆弱的提法，药物清单和复苏命令的提及。
结果：在实施之前，患者的平均年龄为82.6岁（SD7.4），女性为101（50.5%），实施后平均年龄为82.3岁(SD6.9),女性为112岁(56.0%).实施前在医院信函中提到虚弱的比例为12.7%，实施后为15.3%(p=0.09)。实施后出现了更多的GP推荐信(32.0%vs.54.0%,p=0.03),然而，仅在之前的12.5％和之后的7.4％中提到了脆弱（p=0.58）。医院的用药清单交接情况良好(此前为89.3%,94%后，p=0.20)，甚至更好的来自GP(之前为93.8%，100%之后,p=0.19）。实施前59.3%的医院信件中提到了复苏令，实施后57.3%(p=0.77)，高于推荐信(前18.8%，后22.2%(p=0.91)。
结论：RTA的实施提高了GP推荐信的数量；然而，这并没有导致医院和全科医生之间的其他沟通显着改善。报告中仍然经常没有提到虚弱和复苏命令。在成功实施后，可以调查结局的改善情况.
