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Master Thesis

Évaluation de la pertinence des passages aux urgences du centre hospitalier de Chambéry des personnes âgées de 75 ans et plus résidant en EHPAD

Abstract : The attendance of emergency department (ED) by the elderly who are dependent is constantly increasing. This study analyzed the consultation of ED by elderly who are 75 years or older, coming from nursing homes, and described the inappropriate ones. METHOD :Descriptive retrospective epidemiological study conducted from January to June 2014 at the ED of Chambéry Hospital. The assessment of relevance was performed on a grid of explicit criteria with the French version of the Appropriateness Evaluation Protocol (AEPf). The distinction between irrelevant admissions (AEPf-) and the relevant ones (AEPf +) was done and then two experts independently overrode the AEPf-. RESULTS : 465 admissions were included.136 (29,2%) were AEPf-.The AEPf- were less polymedicated (83% versus 68%; p = 0,0003). Most admissions happened during day time (74% versus 65%, p = 0,0081), and on weekdays (78% versus 71%, p = 0,0386). Their hospitalization rate was lower (43% versus 77%, p < 0,001). Among 136 AEPf-: 17 were justified (12,5%), 60 (44%) unjustified, and 59 (43,5%) were subject of disagreement between the experts (k = 0,16, p <0,0001). For the group of unjustified, a diagnostic or therapeutic advice was the main service needed by the patient at ED. After the override, preventability rate was 13,7% according to the expert geriatrician, versus 24,7% for the emergency physician expert. CONCLUSION:The admission of patients from nursing homes were deemed irrelevant in 29,3% of cases. Experts confirm that half of them were not relevant of ED. The preventability rate was assessed differently depending on whether the expert is a geriatrician (13,7%) or an emergency physician (24,7%).
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01163888
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Submitted on : Monday, June 15, 2015 - 4:57:50 PM
Last modification on : Wednesday, July 15, 2020 - 8:58:04 AM
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  • HAL Id : dumas-01163888, version 1

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Élodie Emmanuelle Barnay, Nathalie Cristèle Marques. Évaluation de la pertinence des passages aux urgences du centre hospitalier de Chambéry des personnes âgées de 75 ans et plus résidant en EHPAD. Médecine humaine et pathologie. 2015. ⟨dumas-01163888⟩

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