Geriatric Disorder Clinical Trial
Official title:
Early Geriatric Follow-up After Hospital Discharge in Older Acute Medical Patients - a Quasi Randomized Controlled Trial
The study is a quasi-randomized controlled trial conducted in a Danish University Hospital including older patients admitted to Emergency Department (ED). 'Early geriatric follow-up' is a multidisciplinary geriatric service provided to older patients who are discharged to their home. They receive hospital-visits by a multidisciplinary team no later than 24 hours after discharge (except on sundays). The team is consisting of a physician and a nurse both with geriatric expertise. The physician is responsible for the clinical patient care. The team is available seven days per week/12 hours per day and 24 hour on-call. In the patient's home, the team has the possibility to perform diagnosing and treatment by assessments, medication review, blood tests, subcutaneous fluid therapy, blood transfusions, intravenous antibiotics, rehabilitation and social arrangements. A discharge hand-over supports the caregivers and the GP.
The study is an organizational project, which takes place in a quasi-randomized controlled
design.
Every morning at the conference at the Emergency Department, patients are assessed if they
are suitable for geriatric assessment and intervention and if so assigned to the Geriatric
Team. Then lots are drawn by the Emergency Department's secretary (envelopes in blocks of 10)
about two types of organization that is offered the patients that are admitted that day -
either: 1) 'early geriatric follow-up' that comprises home visits no later than 24 hours
after discharge (=intervention group), or 2) usual care after discharge with 'follow-up
visits' by home care and the patient's GP, if they consider it necessary (=control group).
All the assigned patients are offered comprehensive geriatric assessment and intervention by
the multidisciplinary team working in the ED consisting of a physician, nurse, and therapist,
all with geriatric expertise. The assessment and intervention include evaluation of patient
medication, functional ability, and social conditions.
The decision on transfer to home or to the Geriatric ward is influenced by the randomization
of the day as 'early geriatric follow-up after discharge' means that more patients, with
diseases that would otherwise have required treatment in hospital, can now be treated at
home. Intervention patients who are considered to be too ill for treatment at home will be
transferred to the Geriatric ward and then afterwards will receive 'early geriatric follow-up
after discharge'.
Early follow-up starts with a visit no later than 24 hours after discharge (except for
sundays). The first visit is performed by the Geriatric team and after that a tailored
follow-up is performed as needed up to 30 days after discharge. The intervention can include
services such as medication review, subcutaneous fluid therapy, blood transfusion,
intravenous antibiotic treatment, and further examinations. The team can be contacted by
phone and by e-mail. If the patient is dependent on assistance from home care, is the
intervention performed in close cooperation with those. The home care is in charge of several
daily observations with feedback to the team about the patient's illness and disability. In
the end of the patient pathway, a discharge summary is sent to the patient's GP.
After discharge, the control group patients receive home-visits as usual by the home care and
their GP, if they consider it as necessary. Before discharge, the Geriatric team has
contacted the primary care and announced the discharge and sends a discharge letter. The
Geriatric team is allowed to phone the patients in the control group after discharge to
ensure that everything is in order and to deliver results according to hospital examinations.
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