title: Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department.
abstract: BACKGROUND
  Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department.
  
  
  OBJECTIVE
  The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents.
  
  
  METHODS
  The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year.
  
  
  METHODS
  Patients aged 75 years or over who were discharged from the A&E department.
  
  
  METHODS
  Nursing home patients. Patients without a telephone.
  
  
  METHODS
  Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required.
  
  
  RESULTS
  551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment.
  
  
  CONCLUSIONS
  Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.
authors.affiliation: Department of Accident and Emergency Medicine, Royal Sussex County Hospital, Brighton.
authors.forename: H D
authors.initials: HD
authors.lastname: Poncia
authors.forename: J
authors.initials: J
authors.lastname: Ryan
authors.forename: M
authors.initials: M
authors.lastname: Carver
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010351:Patient Discharge; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013689:Telephone