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Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?
Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?
Objective: Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital.
Results: Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients’ clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients’ general condition, visible frailty, and patients’ ability to manage at home. “Therapy assessment” and patients’ engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes.
Key words
Risk assessment, hospital, older patients, qualitative data, healthcare outcomes, medical notes.
1756-0500
Ibrahim, Kinda
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Owen, Charlotte, Louise
970660f9-538f-44b5-8595-e262cc717086
Patel, Harnish
514aba46-4dc9-4011-b393-ce83c6206754
Baxter, Mark
3415aa9a-8eb0-454e-9b7a-dadb1ce4e5c6
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Aihie Sayer, Avan
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294
Owen, Charlotte, Louise
970660f9-538f-44b5-8595-e262cc717086
Patel, Harnish
514aba46-4dc9-4011-b393-ce83c6206754
Baxter, Mark
3415aa9a-8eb0-454e-9b7a-dadb1ce4e5c6
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Aihie Sayer, Avan
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253

Ibrahim, Kinda, Owen, Charlotte, Louise, Patel, Harnish, Baxter, Mark, May, Carl, Aihie Sayer, Avan and Roberts, Helen (2017) Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital? BMC Research Notes. (doi:10.1186/s13104-017-2705-7).

Record type: Article

Abstract

Objective: Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital.
Results: Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients’ clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients’ general condition, visible frailty, and patients’ ability to manage at home. “Therapy assessment” and patients’ engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes.
Key words
Risk assessment, hospital, older patients, qualitative data, healthcare outcomes, medical notes.

Text
Identifying high risk older inpatients manuscript BMC 13 7 2017
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More information

Accepted/In Press date: 28 July 2017
e-pub ahead of print date: 10 August 2017

Identifiers

Local EPrints ID: 412925
URI: http://eprints.soton.ac.uk/id/eprint/412925
ISSN: 1756-0500
PURE UUID: 461daf0f-a4f2-4437-987b-a6f5c35c9d16
ORCID for Kinda Ibrahim: ORCID iD orcid.org/0000-0001-5709-3867
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 08 Aug 2017 16:31
Last modified: 07 Oct 2020 02:04

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