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. 2023 Nov 29;23(1):787.
doi: 10.1186/s12877-023-04519-4.

The effect of regional transmural agreements on the information transfer of frail older patients

G Fritsche  1 , N Schoonenboom  2 , H Van der Kroon  3 , C E Douma  4 , J Van der Dussen  5 , Mne Verlaan  6 , B Cloosterman  7 , M Heems  8 , A Nepal  9 , E J Toor  10 , A de Rooij  10 , K J van Stralen  11 , J A Lucke  12
Affiliations

The effect of regional transmural agreements on the information transfer of frail older patients

G Fritsche et al. BMC Geriatr. .

Abstract

Introduction: Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital.

Methods: This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of 'hospital letters': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders.

Results: In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91).

Discussion: The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP's. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.

Keywords: ECP nursing home; Emergency Department; Frail older patient; General Practitioner; Information transfer.

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Conflict of interest statement

The authors declare no competing interests.

References

    1. Conroy SP, Stevens T, Parker SG, Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing. 2011;40(4):436–43. doi: 10.1093/ageing/afr060. - DOI - PubMed
    1. Robbert JJ, Gobbens JA. The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): a prospective cohort study among acutely admitted older patients. Arch Gerontol Geriatr. 2020;89. - PubMed
    1. Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, et al. Learning Integrated Health System to mobilize context-adapted knowledge with a Wiki platform to improve the transitions of Frail seniors from hospitals and emergency departments to the community (LEARNING WISDOM): protocol for a mixed-methods implementation study. JMIR Res Protoc. 2020;9(8):e17363. doi: 10.2196/17363. - DOI - PMC - PubMed
    1. Hogervorst VM, Buurman BM, De Jonghe A, van Oppen JD, Nickel CH, Lucke J, et al. Emergency department management of older people living with frailty: a guide for emergency practitioners. Emerg Med J. 2021;38(9):724–9. doi: 10.1136/emermed-2020-210014. - DOI - PubMed
    1. Carmen S, van Dam EOH, Simon P, Mooijaart, Yvo M, Smulders, Riekie CW, de Vet JA, Lucke LC, Blomaard, René HJ, Otten M, Muller, Prabath WB, Nanayakkara Marijke C Trappenburg, Mike J L Peters A narrative review of frailty assessment in older patients at the emergency department. Eur J Emerg Med. 2021;28(4):266–76. doi: 10.1097/MEJ.0000000000000811. - DOI - PubMed

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