Continuity of the Therapeutic Limitation Code: Analysis of the Variables of Admission in the Emergency Service That Are Associated With a Therapeutic Limitation Upon Exit

NCT02682979 | Completed

• 1 other identifier: CHUB-Therapeutic limitations
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Demographically, the geriatric population is expanding. It is also increasingly found in the emergency services.However, emergency services are not designed to accommodate these patients, whose needs are specific. This population is defined by complex physical and psychosocial needs, included in a comprehensive geriatric assessment too complex to be carried out in the emergency services. Many publications focused on ways to prevent potentially avoidable visits to geriatric patients in emergency services. People rely upon a therapeutic limitation code established for these patients to determine the intensity of the care that may be given to them. However, few geriatric patients arriving in the emergency services were already given such a code. As a consequence, the intensity of the care given to these emergency patients is influenced by the perception of the functional and cognitive status of the patient, even if part of this perception is incorrect. Moreover, it is also well established that the outcome of geriatric patients with severe pathologies at admission is often poor and that there is a need to find alternatives to the intensive treatment offered. The goal of this study will be to determine the prevalence of the presence of a therapeutic limitation code in geriatric patients at hospital admission / admission to the emergency department, and when they leave the hospital. This will be carried out for all geriatric patients residing or placed in nursing homes at the end of the hospitalization.The investigators postulate that establishing a therapeutic limitation code for these fragile patients, before they leave the hospital for a nursing home, would reduce the number of future admissions of these patients in the emergency department.

Conditions

Geriatrics

Keywords

therapeutic limitation code; emergency unit admittance

Outcome Measures

Primary Outcomes (2)

• Prevalence of a therapeutic limitation code (hospital admittance)

  The medical files of the patients admitted in the emergency department of the hospital, from 01/04/2015, will be examined in order to determine if they had a therapeutic limitation code upon admittance.

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

• Prevalence of a therapeutic limitation code (hospital discharge)

  The medical files of the patients admitted in the emergency department of the hospital, from 01/04/2015, will be examined in order to determine if received a therapeutic limitation code upon hospital discharge.

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

Secondary Outcomes (9)

• social status

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

• autonomy status

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

• cognitive status

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

• diagnosis

  Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)

• hospitalisation length

  Patients hopitalized from 01/04/2015 till present date (11 months)

Study Arms (1)

Geriatric patients

100 consecutive geriatric patients admitted in the Emergency Department of the Brugmann Hospital, Horta site, from 01/04/2015.

Other: Medical files analysis

Interventions

Medical files analysis OTHER

Retrospective analysis of the medical files according to medical, social and geriatric criteria.

Geriatric patients

Eligibility Criteria

• Age: 75 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

100 consecutive geriatric patients admitted in the emergency department of the Brugmann Hospital, Horta site, from 01/04/2015 till 11/02/2016.

You may qualify if:

• Patients admitted in the hospital via the emergency department and placed in a nursing home upon hospital discharge
• Patients will an available global geriatric evaluation (either realized in the geriatric ward, either realized by the geriatric team)

You may not qualify if:

• if multiple hospitalizations occur during the study length, data related to the first hospitalization only will be analyzed.

Sponsors & Collaborators

• Brugmann University Hospital: lead

Study Sites (1)

CHU Brugmann

Brussels, 1020, Belgium

Location

Related Publications (11)

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  PMID: 14044222 BACKGROUND

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  PMID: 6860082 BACKGROUND

• Yesavage JA. Geriatric Depression Scale. Psychopharmacol Bull. 1988;24(4):709-11. No abstract available.

  PMID: 3249773 BACKGROUND

• Clement JP, Nassif RF, Leger JM, Marchan F. [Development and contribution to the validation of a brief French version of the Yesavage Geriatric Depression Scale]. Encephale. 1997 Mar-Apr;23(2):91-9. French.

  PMID: 9264935 BACKGROUND

• Goring H, Baldwin R, Marriott A, Pratt H, Roberts C. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. Int J Geriatr Psychiatry. 2004 May;19(5):465-71. doi: 10.1002/gps.1115.

  PMID: 15156548 BACKGROUND

• Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941-8. doi: 10.7326/0003-4819-113-12-941.

  PMID: 2240918 BACKGROUND

• Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983 Dec;31(12):721-7. doi: 10.1111/j.1532-5415.1983.tb03391.x.

  PMID: 6418786 BACKGROUND

• Katz PR, Karuza J, Kolassa J, Hutson A. Medical practice with nursing home residents: results from the National Physician Professional Activities Census. J Am Geriatr Soc. 1997 Aug;45(8):911-7. doi: 10.1111/j.1532-5415.1997.tb02958.x.

  PMID: 9256840 BACKGROUND

• Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others? Arthritis Rheum. 2001 May;44(5):1194-202. doi: 10.1002/1529-0131(200105)44:53.0.CO;2-6.

  PMID: 11352254 BACKGROUND

• Katz PP, Morris A. Use of accommodations for valued life activities: prevalence and effects on disability scores. Arthritis Rheum. 2007 Jun 15;57(5):730-7. doi: 10.1002/art.22765.

  PMID: 17530671 BACKGROUND

• Derouesne C, Poitreneau J, Hugonot L, Kalafat M, Dubois B, Laurent B. [Mini-Mental State Examination:a useful method for the evaluation of the cognitive status of patients by the clinician. Consensual French version]. Presse Med. 1999 Jun 12;28(21):1141-8. French.

  PMID: 10399508 BACKGROUND

Study Officials

• Murielle Surquin, MD

  CHU Brugmann

  PRINCIPAL INVESTIGATOR

• Axelle Gregory, MD

  CHU Brugmann

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of clinic

Study Record Dates

• First Submitted: February 11, 2016
• First Posted: February 17, 2016
• Study Start: February 1, 2016
• Primary Completion: December 1, 2017
• Study Completion: December 1, 2017
• Last Updated: January 18, 2018

Record last verified: 2018-01

Locations

BE (1)