Clinical trial NCT02682979: 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
Official title: 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 type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Geriatrics
Keywords: therapeutic limitation code
emergency unit admittance
Lead sponsor: Brugmann University Hospital
Sponsor class: OTHER
First posted: 2016-02-17
Enrollment: 100
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: RETROSPECTIVE
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.

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.

Detailed description: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: Prevalence of a therapeutic limitation code (hospital admittance)
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: Prevalence of a therapeutic limitation code (hospital discharge)
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
Secondary outcomes:
measure: social status
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: autonomy status
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: cognitive status
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: diagnosis
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: hospitalisation length
timeFrame: Patients hopitalized from 01/04/2015 till present date (11 months)
measure: Albumine
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: Hydratation level
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: Unintentional weigh loss
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
measure: Presence of comorbidities
timeFrame: Patients hospitalized from 01/04/2015 till 11/02/2016 (11 months)
Other outcomes:
Locations:
city: Brussels
country: Belgium
facility: CHU Brugmann
Study officials:
affiliation: CHU Brugmann
name: Murielle Surquin, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: CHU Brugmann
name: Axelle Gregory, MD
role: PRINCIPAL_INVESTIGATOR
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