응급의료센터로 전원되는 노인환자의 의료정보 공유정도와 건강결과

Abstract

This study was conducted to examine the relationship between information sharing and health outcomes (length of stay in emergency department, length of stay at the hospital, and unexpected revisit to emergency department) for elderly patients transferred from long-term care hospital or facilities to the emergency department (ED). Also, this study aimed to provide a basic reference in developing standardized methods to improve the level of shared information and health outcomes for such transferred elderly patients. This study analyzed the medical records (initial emergency examination records, emergency progress records, nursing records, and referral forms) for 452 cases of 362 elderly patients aged 65 years or older who were transferred from July 1, 2017 to June 30, 2018 from long-term care hospitals or facilities to the ED in a university hospital with more than 600 beds located in a city in Korea. The following are this study's results: 1) The total number of cases where the participants were referred was 452; women accounted for 302 (66.8%), and the average age was 82.58 (±7.92) years. In the type of health institution from which the participants were referred, "long-term care facilities" accounted for the most with 275 cases (60.8%), and "long-term care hospitals" accounted for 177 cases (39.2%). When it came to reasons for referral, disease (94.0%) accounted for the most cases. Regarding consciousness status in referrals, the "alert" accounted for 269 cases (59.5%). In the charlson comorbidity index, those with "3 points or higher" accounted for the most with 142 cases (48.9%). Outcomes after ED examination showed that "Admission" accounted for the most with 278 cases (61.5%). 2) With regard to the characteristics of the participants, sex (χ2=13.97, p<.001), age (t=-4.47, p<.001), charlson comorbidity index (t=5.44, p<.001), and outcome after ED examination (χ2=26.80, p<.001) showed significant differences between types of health institutions from which they were transferred. 3) The number of shared information items was 1.33 (±2.45) on average. In terms of the number of shared information items depending on the type of health institution that transferred the patients, long-term care hospitals showed 3.35 (±2.92), which was significantly higher than 0.04 (±0.25) from long-term care facilities (t=15.01, p<.001). 4) In the relationship between the level of shared information and health outcomes, the length of stay in ED had a significantly negative correlation with the level of shared information (r=-.101, p=.032). Based on the above results, the number of the shared information items from long-term care hospitals was 3.35 (±2.92) on average out of 19, with a minimum of 0 to a maximum of 9. Meanwhile, for long-term care facilities, it was from 0 to 2 with 0.04 (±0.25) on average. It was revealed that a lot of information was missing when the patients were transferred to the ED, and the higher the number of shared information items, the shorter was the length of stay in ED. In other words, it seems that the time required to examine patients can be reduced and the patient status can be identified more effectively when more information is shared between institutions during referral, and subsequently, it influences the reduction in the length of stay in ED. Nonetheless, this study found that the level of shared information had no significant correlation with length of stay at the hospital or unexpected ED revisit. Hence, it would be necessary to add the factors that may affect length of stay at hospitals or unexpected ED revisits and conduct follow-up studies repeatedly.