Discharge planning at a regional New Zealand hospital Emergency Department: Screening elderly patients for early multidisciplinary team referral using the Elders Risk Assessment Index

BACKGROUND Emergency nursing is a specialty concerned with the care of patients across the lifespan. Research has shown sixty per cent of presentations to the Emergency Department (ED) are not emergency presentations; they are classed as semi or non-urgent and are discharged home. Research also shows that ED use among elderly patients is everincreasing and the elderly population is at increased risk of return visits to ED. Effective discharge planning from the ED to home assists patients who are frail, have a lack of home support, who are co-morbid and have complex medication regimes to remain safely at home. Early screening of elderly patients at triage can act as a guide to predict their journey, their safety at discharge and the need for multi-disciplinary team (MDT) input prior to discharge. A number of screening tools exist to risk-screen elderly patients and use an array of data collection methods including: nurse gathered data, patient self-reporting, proxy information and information from administrative data. The Elders Risk Assessment (ERA) Index uses administrative data and was developed to overcome barriers associated with patient self-reporting, nurse gathered data and proxy information. AIM This retrospective observational study was designed to investigate the potential for the ERA index score to predict MDT referrals of the elderly >65 years of age same-day discharges from ED to home for the eleven-month period between 1 July 2011 and 31 May 2012 and to identify specific variables of MDT referral which were not able to be identified by the ERA tool. METHOD A quantitative, retrospective observational approach was used in this study. Data were collected over an eleven-month period from July 2011 to May 2012 inclusive, using an administrative database with permission from the research DHB. The purposive sample consisted of patients >65 who were treated and discharged home from the DHB ED. Approval from the Eastern Institute of Technology Research (EIT) and Ethics Committee for research was received for this study. Data were analysed using Microsoft Excel 2007™ and the Statistical Package for Social Sciences™ (SPSS). RESULTS The results of this analysis showed the significant variables related to MDT referral were an ERA score >16, age >70 years, a history of a previous hospital admission in the previous 2 years >5 days, a history of a diagnosis of COPD, female gender, not being married, being of European descent and presenting on a Monday-Friday between 0700-1630 hours. The significant variables related to non-referral were identified as age range 65-70years, a marital status of married/de-facto, male gender, Māori descent and an afterhours presentation. CONCLUSION This study showed that excluding mobility, there are significant variables which are able to be abstracted from an electronic data-base that may serve as a means to riskscreen elderly patients. The hypothesis of using the ERA index score >16 was supported by this study. However, there were variables within the ERA index which showed no significant relationship with MDT referral. This study also showed that characteristics not included in the ERA index were significantly related to MDT referral (gender, ethnicity and presentation time to the ED). The results of this study have shown the significant variables related to MDT referral applied to the ERA index include; an age of > 80 years, an ERA score >16, a hospital length of stay in the previous two years of > 5days and a history of COPD. Furthermore, this study found inconsistencies among patients selected for MDT referral at the research DHB. Consequently, this study confirms the necessity for a standardised referral process which would be supported by a valid risk-screening tool.

Name thesis:degree_name

Master of Nursing

Level thesis:degree_level

Masters

Grantor

Eastern Institute of Technology

Year dc:date.issued

2013

Author dc:creator

• Hegarty, Carolyn

• New Zealand
• emergency departments (EDs)
• discharge planning
• older people
• Māori older people
• risk assessment
• screening tools
• Elders Risk Assessment (ERA) Index
• referrals
• multidisciplinary teams

Statement dc:rights

• All rights reserved

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10652/6462

OAI identifier oai:identifier

oai:null:10652/6462