1 Syddansk Forskningscenter for Klinisk Sygepleje (SFKS), Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 unknown3 Syddansk Forskningscenter for Klinisk Sygepleje (SFKS), Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU
Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80 % of geriatric patients have complex and often unresolved caring needs. The objective was to examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective, randomized, controlled trial with follow-up at one and six months. Included were patients >70 at increased risk of readmission and functional decline (had an ISAR 1 score of 2-6 points) and discharged home in the period 16th of February 2009 to 31st of January 2011, N=271. Intervention: A nurse did a brief nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms; health related quality of life; and hours of help received from the community. Conclusion: Results collected at one and six months follow-up, will show if a two-stage intervention consisting of screening with the ISAR 1 tool followed by structured nursing assessment and intervention in the ED could be a way of discovering geriatric patients’ unresolved problems and preventing further functional decline and readmission.