• H D Poncia, J Ryan, and M Carver.
• Department of Accident and Emergency Medicine, Royal Sussex County Hospital, Brighton.
• J Accid Emerg Med. 2000 Sep 1; 17 (5): 337-40.

BackgroundPatients 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.ObjectivesThe 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.SettingThe study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year.Inclusion CriteriaPatients aged 75 years or over who were discharged from the A&E department.Exclusion CriteriaNursing home patients. Patients without a telephone.Study DesignPre-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.Results551 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.ConclusionsTelephone 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.

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