Factors and post-discharge outcomes associated with patients' readiness for discharge from the emergency medicine ward: A prospective study.

BACKGROUND: Discharging patients with a self-reported low readiness for hospital discharge (RHD) may be challenging, as these patients may be vulnerable to risks and adaptation issues that can delay recovery. However, little is known about whether emergency medicine ward (EMW) patients are sufficiently prepared for discharge to home. Therefore, the aim of this study is to examine the factors and outcomes associated with patients' RHD in an EMW setting. METHODS: One hundred and eighty-four patients were recruited from the EMW of a tertiary hospital in Hong Kong. Cross-sectional data were collected from self-administered questionnaires and patients' medical records at the time of discharge and 1 month later. Descriptive statistics were obtained, and the variables were subjected to multivariable regression analyses. RESULTS: Seventy-three patients (40%) reported a low RHD at the time of discharge. Living with someone was a factor contributing to a patient's perceived RHD. A greater RHD was associated with a lower risk of 30-day emergency department readmission (odds ratio [OR] = 0.75; 95% confidence interval [CI] = 0.57-0.99) and hospital readmission (OR = 0.59; 95% CI = 0.38-0.91). However, patients who reported higher scores on the knowledge RHD subscale had a higher risk of hospital readmission (OR = 2.34; 95% CI = 1.38-3.98). CONCLUSION: These findings demonstrate the importance of paying careful attention to social support network of patients and the provision of patient education, as these may improve patients' RHD prior to discharge from the EMW. (242 words).

Geriatric consultation service in emergency department: how does it work?

BACKGROUND: Hong Kong is having a significant prevalence of geriatric patients who usually require admission after presentation to the hospital through emergency departments. The geriatric consultation programme 'We Care' aims at lowering acute geriatric medical admission. OBJECTIVES: The study aims at analysing the impact of the geriatric consultation service on the acute medical admission, and to study the characteristics and outcome of geriatric patients. METHODS: Retrospective study. Patients who received geriatric consultations during 1 January 2009 to 1 March 2011 were enrolled. The demographic information, diseases case mix, venue of discharge, clinical severity, community nursing service referrals and adverse outcomes were retrieved and analysed. The incidence of adverse outcomes under the presence of each factor was studied. RESULTS: 2202 geriatric patients were referred. Their age ranged from 45 to 99 (mean 79.91, SD 7.45, median 80). These cases were categorised into: (1) chronic pulmonary disease (n=673; 30.6%), (2) debilitating cardiac disease (n=526; 23.9%), (3) geriatric syndromes (n=147; 6.7%), (4) neurological problems (n=416; 18.9%), (5) diabetes-related problems (n=146; 6.6%), (6) terminal malignancy (n=39; 1.8%), (7) electrolyte or input/output disturbance (n=137; 6.2%), (8) non-respiratory infections (n=36, 1.6%) and (9) others (n=82; 3.7%). Acute medical admission was evaded in 84.7% of all consultations with 1039 (47.2%) patients discharged home and 825 patients (37.5%) admitted to convalescent hospital. The incidence rate of adverse outcomes was 1.6%. CONCLUSION: Programme 'We Care' provided comprehensive geriatric assessment to suitable geriatric patients, resulting in an effective reduction of acute geriatric hospital admission.