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cover of episode Saving elderly patients from the hazards of the ER

Saving elderly patients from the hazards of the ER

2025/3/14
logo of podcast White Coat, Black Art

White Coat, Black Art
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People
B
Brian Goldman
J
Julia Chabot
J
Julia Shabbat
L
Lisa Paoloni
R
Rob Drummond
Topics
Brian Goldman: 75岁及以上的老年患者住院可能会造成可预防的灾难，住院时间越长，他们的身体状况越差，有些人甚至可能因此无法回家。因此，我访问了蒙特利尔圣玛丽医院的急诊室，那里有一个专门的团队致力于在不良事件发生之前将老年患者送回家。 Lisa Paoloni: 我们团队积极主动地识别可以快速干预并当天出院的急诊老年患者。我们筛查75岁以上具有老年特征且患有老年综合征（如跌倒、谵妄等）的急诊患者，以及85岁以上或具有特定虚弱程度的髋部骨折患者，以便及时告知老年病医生进行术前谵妄预防。我们努力让老年患者尽快离开急诊室，减少他们在急诊室停留的时间，因为长时间停留会加剧虚弱。老年医学应该采取基于优势的方法，关注老年人的优势而非缺陷。 Julia Shabbat: 我们努力预防老年患者在急诊室可能发生的医源性并发症，例如谵妄，因为这些并发症会阻止他们回家。老年患者在急诊室过夜可能会导致谵妄等并发症，从而无法出院。在老年医学中，住院并不总是对患者最好的选择，因为住院可能导致并发症，例如谵妄和肌无力。在老年患者出现谵妄或跌倒之前，我们只有几个小时的窗口期来采取干预措施。 Rob Drummond: 老年患者在急诊室停留会增加发病率和死亡率的风险，因为急诊室的环境不适合老年人。老年病团队积极主动，了解系统中的各个参与者，并能提供我作为急诊医生无法提供的细致护理。

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Chapters
The geriatric team at St. Mary's Hospital in Montreal is dedicated to preventing complications in elderly patients in the emergency department. They focus on early identification and intervention to facilitate timely discharges.
  • The team proactively identifies patients over 75 with a geriatric profile.
  • Screening includes falls, delirium, hip fractures, and a PRISMA-7 frailty scale.
  • The team aims to minimize time spent in the ER to prevent deconditioning.
  • Dr. Julia Chabot emphasizes preventing iatrogenic complications like delirium.
  • A small window of opportunity exists before complications like delirium set in.
  • The team includes geriatricians, nurses, physiotherapists, and social workers.

Shownotes Transcript

It may seem counterintuitive, but hospital emergency rooms can be hazardous to the health of elderly patients. An innovative geriatric multidisciplinary ER team at St. Mary's Hospital in Montreal is getting elderly patients discharged quickly and safely, saving them from preventable harms and the hospital millions in preventable admissions.