Continuity of the Therapeutic Limitation Code: Analysis of the Variables of Admission in the Emergency Service That Are Associated With a Therapeutic Limitation Upon Exit
NCT ID: NCT02682979
Last Updated: 2018-01-18
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
100 participants
OBSERVATIONAL
2016-02-01
2017-12-01
Brief Summary
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Many publications focused on ways to prevent potentially avoidable visits to geriatric patients in emergency services. People rely upon a therapeutic limitation code established for these patients to determine the intensity of the care that may be given to them. However, few geriatric patients arriving in the emergency services were already given such a code.
As a consequence, the intensity of the care given to these emergency patients is influenced by the perception of the functional and cognitive status of the patient, even if part of this perception is incorrect. Moreover, it is also well established that the outcome of geriatric patients with severe pathologies at admission is often poor and that there is a need to find alternatives to the intensive treatment offered.
The goal of this study will be to determine the prevalence of the presence of a therapeutic limitation code in geriatric patients at hospital admission / admission to the emergency department, and when they leave the hospital. This will be carried out for all geriatric patients residing or placed in nursing homes at the end of the hospitalization.The investigators postulate that establishing a therapeutic limitation code for these fragile patients, before they leave the hospital for a nursing home, would reduce the number of future admissions of these patients in the emergency department.
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Detailed Description
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Several options are investigated worldwide to properly manage these fragile patients:
* Scales of frailty and functional decline screening
* Specialized care units: the Mobile Geriatric Team, the Emergency short-stay units, the acute care geriatric unit, the geriatric nurse liaison model, or a service specific geriatric emergency.
Many publications focused on ways to prevent potentially avoidable visits to geriatric patients in emergency services. People rely upon a therapeutic limitation code established for these patients to determine the intensity of the care that may be given to them. However, few geriatric patients arriving in the emergency services were already given such a code.
As a consequence, the intensity of the care given to these emergency patients is influenced by the perception of the functional and cognitive status of the patient, even if part of this perception is incorrect. Moreover, it is also well established that the outcome of geriatric patients with severe pathologies at admission is often poor and that there is a need to find alternatives to the intensive treatment offered.
The goal of this study will be to determine the prevalence of the presence of a therapeutic limitation code in geriatric patients at hospital admission / admission to the emergency department, and when they leave the hospital. This will be carried out for all geriatric patients residing or placed in nursing homes at the end of the hospitalization.The investigators postulate that establishing a therapeutic limitation code for these fragile patients, before they leave the hospital for a nursing home, would reduce the number of future admissions of these patients in the emergency department.
Furthermore, this study offers the prospective to establish in the future a systematic implementation of the therapeutic limitation code for geriatric patients residing in nursing homes, therefore anticipating the various issues specific to his population in the emergency department.
Conditions
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Study Design
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OTHER
RETROSPECTIVE
Study Groups
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Geriatric patients
100 consecutive geriatric patients admitted in the Emergency Department of the Brugmann Hospital, Horta site, from 01/04/2015.
Medical files analysis
Retrospective analysis of the medical files according to medical, social and geriatric criteria.
Interventions
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Medical files analysis
Retrospective analysis of the medical files according to medical, social and geriatric criteria.
Eligibility Criteria
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Inclusion Criteria
* Patients will an available global geriatric evaluation (either realized in the geriatric ward, either realized by the geriatric team)
Exclusion Criteria
75 Years
ALL
No
Sponsors
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Brugmann University Hospital
OTHER
Responsible Party
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Murielle Surquin
Head of clinic
Principal Investigators
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Murielle Surquin, MD
Role: PRINCIPAL_INVESTIGATOR
CHU Brugmann
Axelle Gregory, MD
Role: PRINCIPAL_INVESTIGATOR
CHU Brugmann
Locations
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CHU Brugmann
Brussels, , Belgium
Countries
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References
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KATZ S, FORD AB, MOSKOWITZ RW, JACKSON BA, JAFFE MW. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963 Sep 21;185:914-9. doi: 10.1001/jama.1963.03060120024016. No abstract available.
Folstein MF, Robins LN, Helzer JE. The Mini-Mental State Examination. Arch Gen Psychiatry. 1983 Jul;40(7):812. doi: 10.1001/archpsyc.1983.01790060110016. No abstract available.
Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24(4):709-11. No abstract available.
Clement JP, Nassif RF, Leger JM, Marchan F. [Development and contribution to the validation of a brief French version of the Yesavage Geriatric Depression Scale]. Encephale. 1997 Mar-Apr;23(2):91-9. French.
Goring H, Baldwin R, Marriott A, Pratt H, Roberts C. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. Int J Geriatr Psychiatry. 2004 May;19(5):465-71. doi: 10.1002/gps.1115.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941-8. doi: 10.7326/0003-4819-113-12-941.
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983 Dec;31(12):721-7. doi: 10.1111/j.1532-5415.1983.tb03391.x.
Katz PR, Karuza J, Kolassa J, Hutson A. Medical practice with nursing home residents: results from the National Physician Professional Activities Census. J Am Geriatr Soc. 1997 Aug;45(8):911-7. doi: 10.1111/j.1532-5415.1997.tb02958.x.
Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others? Arthritis Rheum. 2001 May;44(5):1194-202. doi: 10.1002/1529-0131(200105)44:53.0.CO;2-6.
Katz PP, Morris A. Use of accommodations for valued life activities: prevalence and effects on disability scores. Arthritis Rheum. 2007 Jun 15;57(5):730-7. doi: 10.1002/art.22765.
Derouesne C, Poitreneau J, Hugonot L, Kalafat M, Dubois B, Laurent B. [Mini-Mental State Examination:a useful method for the evaluation of the cognitive status of patients by the clinician. Consensual French version]. Presse Med. 1999 Jun 12;28(21):1141-8. French.
Other Identifiers
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CHUB-Therapeutic limitations
Identifier Type: -
Identifier Source: org_study_id
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