The effect of regional transmural agreements on the information transfer of frail older patients.

Autor: Fritsche G; Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands., Schoonenboom N; Department of Neurology, Spaarne Gasthuis, Haarlem, The Netherlands., Van der Kroon H; Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands., Douma CE; Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands., Van der Dussen J; General Practitioner, Rijsenhout, The Netherlands., Verlaan M; General Practitioner, Haarlem, The Netherlands., Cloosterman B; General Practitioner, Badhoevedorp, the Netherlands., Heems M; Elderly Care Physician, Amstelring, Hoofddorp, The Netherlands., Nepal A; Elderly Care Physician, Zorgbalans, Haarlem, The Netherlands., Toor EJ; Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands., de Rooij A; Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands., van Stralen KJ; Spaarne Gasthuis Academy, Spaarne Gasthuis, Hoofddorp, The Netherlands., Lucke JA; Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands. jlucke@spaarnegasthuis.nl.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2023 Nov 29; Vol. 23 (1), pp. 787. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1186/s12877-023-04519-4
Abstrakt: Introduction: 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.
Methods: 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.
Results: 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).
Discussion: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: