Preventable presentations of older adults to emergency departments: General practitioners' perspectives.

OBJECTIVE: To describe general practitioners' (GP) perspectives of older patients presenting to the ED, reasons they would refer to the ED and how they utilise community services to help manage older adults. METHODS: A descriptive study conducted in the Sutherland Shire, Sydney. Case files were compiled using electronic medical records for 50 patients over 70 years old who presented to the ED of The Sutherland Hospital, a teaching hospital in Sydney. Surveys were provided to 10 GPs who each analysed five patients' presentations. Primary outcome was whether the GP would refer the patient to the ED. Secondary outcomes included reasons GPs referred to the ED, and their referral patterns of local community services. RESULTS: Of the 50 patients who presented to the ED, GPs would have referred 21 (42%) to the ED and managed 29 (58%) in the community. The most common reasons GPs would have referred to the ED was that they were 'too unwell', or needed 'urgent imaging or blood tests'. In 26 (52%) of the patients, GPs were aware of a local service that could help manage the patient and would have made that referral in 21 (42%) patients. Rapid Access Diagnosis and Intervention Unit and Geriatric Flying Squad are two of the local aged care services GPs would have referred to most commonly. CONCLUSION: GPs reported they would have been able to manage a significant proportion of older adults who presented to the ED in the community without referring to the ED. Severe and acute illness requiring urgent evaluation and intervention was the main reason GPs would refer to the ED.

Southcare Geriatric Flying Squad: an innovative Australian model providing acute care in residential aged care facilities.

This study reviews the outcomes of a model developed to improve the quality of care of residents living within residential aged care facilities (RACF). The Southcare Geriatric Flying Squad saw a total of 640 acutely unwell RACF residents over an 18-month period. Of these, 578 (90.3%) were managed in the RACF avoiding emergency department. Only 35 (5.5%) patients required emergency department transfer and 27 (4.2%) were directly admitted to a medical ward. The service may have reduced emergency presentations by offering rapid assessment and management, choice in place of treatment and level of interventions.

Outcomes of a behavioral unit in an acute aged care service.

This study involves a retrospective review of the patients admitted to a unit providing specialized management to patients displaying difficult behaviors due to delirium and/or dementia. Medical records from 45 consecutive admissions have been reviewed. A great proportion of patients had dementia with superimposed delirium. Compared to care in general aged care wards, there was no reduction in length of stay (LOS) of patients in this study, ostensibly due to the delayed placement for long-term care. However there was a marked reduction in fall incidence and lesser use of 'specials'. Psychotropic medications (PMs) were frequently used but their indications were carefully reviewed. Upon discharge there was improvement in the behavioral profile of the patients. Questionnaires completed by carers and staff were used to further assess the efficacy of the unit. There was general satisfaction of the care provided in the unit whist a few areas have been identified that require further attention. This model of intervention presents an improvement to the quality of care for acutely ill elderly patients with behavioral problems.

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty.

We use vertebroplasty for patients with the most severe pain caused by osteoporotic vertebral fractures less than 6 weeks old, and have observed dramatic pain relief in this acute setting. A recent editorial in the Journal, written by the authors of two recent vertebroplasty trials, suggested that vertebroplasty is not an effective therapy for acute osteoporotic vertebral fractures. The trials described in the editorial sampled a very different patient cohort to the one that we treat with vertebroplasty. Our clinical experience and most of the published literature relating to the benefits of vertebroplasty are in striking contrast to the opinions presented in that editorial.

The management of patients with hip fractures who are taking Clopidogrel.

AIM: To assess the outcomes of patients with acute proximal hip fractures who were taking Clopidogrel. METHOD: A retrospective study of 135 patients with proximal hip fractures. Demographic data and clinical outcomes were collected via review of hospital medical records. RESULTS: 21 patients taking Clopidogrel on admission were compared with 114 patients not on Clopidogrel. The groups were similar in their baseline characteristics. Postoperative haemoglobin and wound haematoma, hospital length of stay and death rate were similar in both groups even when the patients on Clopidogrel were operated on within 2 days of fracture. Days to surgery were longer in the Clopidogrel group than the control group (3.5 vs 0.9). CONCLUSIONS: This study demonstrated that patients on Clopidogrel do not have a worse outcome than those who were not taking the medication. We feel that it is safe to perform surgery as soon as possible.