背景:在急症医院环境中等待监护和财务管理(FM)听证会的患者会经历延长的住院时间(LOS),对虚弱的老人有已知的后果。这个,再加上普遍同意替代决策是最后的手段,必须检查老年住院患者在医院内的监护和FM申请。
目的:本研究旨在研究公立医院老年住院患者的监护应用过程,包括:转诊的原因和结果;并探讨与应用标准相关的病历内容。
方法:这是一个混合方法观察病例系列,使用描述性数据,并补充了2018年至2020年在新南威尔士州老年医学住院病房转诊监护(有/无FM)的住院患者的定性病例记录分析。检查了医疗记录,以确定监护的可操作性标准,与残疾保持一致,大多数澳大利亚司法管辖区共有的能力和需求/风险。
结果:在45名申请监护的患者中,98%的人被授予监护人,37份调频申请中有33份(89%)。多重风险支撑着应用程序,最常见的跌倒(49%)和药物管理不善(49%)。虽然只有29%的人在入院前接受服务,98%的人出院接受住院治疗。平均医院距离为70天(四分位数间距,35),导致入院和决定申请监护/FM(中位数,28天住院)和不确定性或缺乏记录的容量评估。
结论:这项研究确定了医院监护路径的潜在点,这可能是为了精简,如果不转移这些应用程序中的一些。干预点包括在申请开始时,通过解决患者需求和使用支持的决策来考虑替代决策的替代方案,同时提高临床医生对能力评估和监护的理解。
Patients in acute hospital settings waiting for guardianship and financial management (FM) hearings experience extended length of stay (LOS), with known consequences for frail elderly. This, together with universal agreement that substitute decision-making is a last resort measure, an imperative exists to examine guardianship and FM applications made from within hospital for geriatric inpatients.
This study aims to examine processes around Guardianship applications in a public hospital Geriatric inpatient setting including times to, reasons for and outcomes of referral; and to explore the content of the medical records in relation to criteria for application.
This was a mixed methods observational
case series using descriptive data supplemented by qualitative
case-note analysis of inpatients referred for guardianship (with/without FM) from 2018 to 2020 in a New South Wales Geriatric Medicine inpatient unit. Medical records were examined for evidence of operationalised criteria for guardianship, aligned with disability, capacity and need/risk common to most Australian jurisdictions.
Of 45 patients with guardianship applications, 98% were granted guardians and 33 of 37 (89%) FM applications. Multiple risks underpinned applications, most commonly frequent falls (49%) and medication mismanagement (49%). Although only 29% were in receipt of services preadmission, 98% were discharged to residential care. Average hospital LOS was 70 days (interquartile range, 35), contributed to by delays between admission and decision to apply for guardianship/FM (median, 28 inpatient days) and uncertainties around or lack of documented capacity assessments.
This study identifies potential points along pathways towards guardianship in hospital settings, which might be targeted to streamline if not divert some of these applications. Points of intervention include at initiation of applications, with consideration of alternatives to substitute decision-making by addressing patient needs and using supported decision-making, while improving clinician understanding of capacity assessment and guardianship.