노인요양병원으로부터 응급의료센터로 전원된 환자의 역학적 특징 분석-사례군 연구

Abstract

Purpose: Nursing homes continue to increase in number,and more residents are being transferred to emergency departments (EDs). The objective of this study was to investigate the overall characteristics of residents who were transferred to the ED and follow-up their course of treatments. Methods: We identified nursing home residents aged 65years and older who had been transferred to the ED of a regional tertiary university medical center from January 2008 to December 2009. Further attention was paid to those who had been diagnosed with sepsis. Meantime, a separate cohort of sepsis patients was collected, made up of geriatric patients aged 65 years or older who had visited the ED voluntarily from home or through medical institutions other than nursing homes during the same period. We then compared the two cohorts of sepsis patients. Results: A total of 321 patients aged 65 years or older were transferred from nursing homes during the study period. Their mean age was 77.6±7.2 years, and 172 (54.8%)were females. Seventy six (24.2%) patients whose caregivers did not comply with the necessary procedures or refused aggressive management were discharged home or were retransferred to nursing homes. A total of 41 sepsis patients had been transferred from nursing homes, whereas 64 patients had visited the ER voluntarily or through medical institutions other than nursing homes. Even though the difference between the two groups was not significant statistically, patients transferred from nursing homes tended to be discharged or retransferred to nursing homes with inadequate treatment. Conclusion: A considerable number of patients transferred from nursing homes were found to be discharged or retransferred to nursing homes during acute care due to refusal of aggressive treatments. Likewise, the comparison of sepsis patients between the two arms showed a greater portion being retransferred with inadequate treatment as well as a greater rate of mortality among patients transferred from nursing homes.