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

Study Overview
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Brief Summary
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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.

Detailed Description
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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. The multidisciplinary care they need takes time. Several options are investigated worldwide to properly manage these fragile patients: Scales of frailty and functional decline screening Specialized care units: the Mobile Geriatric Team, the Emergency short-stay units, the acute care geriatric unit, the geriatric nurse liaison model, or a service specific geriatric emergency. 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. Furthermore, this study offers the prospective to establish in the future a systematic implementation of the therapeutic limitation code for geriatric patients residing in nursing homes, therefore anticipating the various issues specific to his population in the emergency department.

Official Title
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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

Conditions
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Geriatrics

Intervention / Treatment
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* Other: Medical files analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 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) Exclusion Criteria: if multiple hospitalizations occur during the study length, data related to the first hospitalization only will be analyzed.

Ages Eligible for Study
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Minimum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Geriatric patients<br>100 consecutive geriatric patients admitted in the Emergency Department of the Brugmann Hospital, Horta site, from 01/04/2015. | Other: Medical files analysis<br>* Retrospective analysis of the medical files according to medical, social and geriatric criteria.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| social status | Retrospective analysis of patient medical files. The investigators will evaluate if the social status of the patient is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| autonomy status | Retrospective analysis of patient medical files.The investigators will evaluate if the autonomy of the patient is linked to a therapeutic limitation decision upon hospital discharge. Patient autonomy is evaluated by the results of either of these two tests: the Sherpa test or the Katz scale. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| cognitive status | Retrospective analysis of patient medical files.The investigators will evaluate if the cognitive status of the patient is linked to a therapeutic limitation decision upon hospital discharge. The patient cognitive status is evaluated by the results of either the confusion assessment method or the mini mental state evaluation test. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| diagnosis | Retrospective analysis of patient medical files.The investigators will evaluate if the admission motive/established diagnosis is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| hospitalisation length | Retrospective analysis of patient medical files.The investigators will evaluate if the hospitalisation length is linked to a therapeutic limitation decision upon hospital discharge. | Patients hopitalized from 01/04/2015 till present date (11 months) | 
| Albumine | Retrospective analysis of patient medical files.The investigators will evaluate if the nutrition status (albumine measurement) is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| Hydratation level | Retrospective analysis of patient medical files.The investigators will evaluate if the hydration level (combined sodium and creatinine/urea measurement) is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| Unintentional weigh loss | Retrospective analysis of patient medical files.The investigators will evaluate if an unintentional weigh loss is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 
| Presence of comorbidities | Retrospective analysis of patient medical files.The investigators will evaluate if the presence of comorbidities (dementia or severe cardiac decompensation or cancer or pneumonia or severe cardio-vascular diseases or hepatic insufficiency) is linked to a therapeutic limitation decision upon hospital discharge. | Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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therapeutic limitation code, emergency unit admittance