Title : Advanced nurse practitioner led falls service for older adults discharged from the emergency department: A retrospective analysis of clinical data
Abstract:
Older adults presenting to Emergency Departments (EDs) frequently experience complex health and social care needs, including frailty, carer stress, decline in mobility, recurrent falls, and cognitive impairment.
Aim: The pathway was to provide a nurse led community based comprehensive geriatric assessment for older adults discharged from the emergency department. The nurse led clinic enables the nurse to address any health and social care needs within the comprehensive framework of integrated care services for older people and link patients in with specialist geriatric teams where necessary reducing avoidable admissions.
Methods: Retrospective data analysis of clinical case notes for patients seen within the service was undertaken. Data collected was based on a referral pathway for older adults age 65 and older who had presented to the ED, had sustained a fall, had reduced mobility, new confusion or were deemed to be in social crisis be that from carer stress or other. Through conducting a service review to explore common themes among referrals for the first 100 patients seen. Using a qualitative approach, content from the overall theme of the consultation was analysed to explore common themes and identify concepts gaining insight and meaning into the into the nature of the consult. Through an iterative process; quantifying frequency of words, phrases and concepts, empirical evidence emerged uncovering a new phenomenon within the study.
Results: Over 100 patients were referred and seen within the first year. Overall, the service received 3 referrals per week All patients were seen within the 2 week time frame unless the patient chose to delay the appointment. Where patients could not attend, a home visit was offered on a case by case basis. Not all patients could benefit from the service due to residing out of the local catchment area. Themes for the reason for referral aligned with the pathway referral criteria to include: Reduced mobility recurrent falls. New / suspected cognitive impairment. Poly pharmacy multi-comorbidity carer stress. These themes do not occur in isolation but are more frequent in combination. Exploring the inpatient data base, a three month review of the number of patients returning to ED demonstrated that 62 % did not return in 3 months. 16 % did return but for other reasons than the initial referral and 22% data unknown. Empirical data highlighted that of the themes common to the majority of presentations included aspects of psychological stressors which triggered further social worker and other agencies that support psychological wellbeing referrals to the medical.
Conclusion: The service analysis identified emerging themes common to the majority of referrals concerning aspects of psychological frailty. This emerging theme identifies an area of interest previously unexplored within the service worthy of further research into the psychological support for older adults discharged from the ED and the challenges and that this age group face many challenges around transitioning from the ED to home. The referral pathway and clinical consult offered space to explore concerns in a holistic manner away from the noisy busy ED in a community setting.
