Leiden University Scholarly Publications

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Loon, M. van (2023)

Proactive care programs in the emergency department: effectiveness and feasibility

Doctoral Thesis
In this thesis, the effectiveness and feasibility of two proactive care programs, implemented in the emergency department (ED) of Haaglanden Medical Center in The Hague are evaluated. The first part of the thesis focuses on a screening and intervention program for hazardous alcohol use in adult ED patients. Although in the subset of patients reached for follow-up, receiving an intervention was associated with reduced alcohol consumption after three months, many patients were not screened and less than half of eligible patients received an intervention. Moreover, risk factors for hazardous alcohol use were more common in unscreened than in screened patients. In the second part of the thesis, the effect of telephone follow-up after ED discharge for community-dwelling older patients on health-related outcomes, including unplanned hospital admissions and ED return visits within 30 days, is examined. As the intervention turned out not to be effective, we investigated reasons for...Show moreIn this thesis, the effectiveness and feasibility of two proactive care programs, implemented in the emergency department (ED) of Haaglanden Medical Center in The Hague are evaluated. The first part of the thesis focuses on a screening and intervention program for hazardous alcohol use in adult ED patients. Although in the subset of patients reached for follow-up, receiving an intervention was associated with reduced alcohol consumption after three months, many patients were not screened and less than half of eligible patients received an intervention. Moreover, risk factors for hazardous alcohol use were more common in unscreened than in screened patients. In the second part of the thesis, the effect of telephone follow-up after ED discharge for community-dwelling older patients on health-related outcomes, including unplanned hospital admissions and ED return visits within 30 days, is examined. As the intervention turned out not to be effective, we investigated reasons for unplanned ED return visits in older adults to assess whether post-ED discharge interventions are sufficiently attuned to the reasons for unplanned ED return.
In conclusion, none of the interventions were effective. Moreover, feasibility of the programs was limited, as many eligible patients were not reached, due to both staff-related and patient-related reasons.
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Emergency Department
Hazardous alcohol drinking
Alcohol screening
Brief intervention
Older patients
Geriatric
Post-discharge follow-up
Emergency department return
All authors
Loon, M. van
Supervisor
Mast, R.C. van der; Gussekloo, J.
Co-supervisor
Linden, M.C. van der
Committee
Mooijaart, S.P.; Rooij, S.E.J.A. de; Buurman, B.M.; Giltay, E.J.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2023-04-13
ISBN (print)
9789464588330

Funding

Sponsorship
Jacobus Foundation, The Hague; Spoedeisende Geneeskunde Onderzoeksfonds; Landsteiner Instituut; Nederlandse Vereniging voor Spoedeisende Hulp Artsen