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... 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. Show less
Loon, M. van; Mast, R.C. van der; Linden, M.C. van der; Gaalen, F.A. van 2020
BackgroundRoutine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures... Show moreBackgroundRoutine screening programmes for hazardous alcohol use in the ED miss large numbers of patients. We investigated whether patient-related or staff-related factors cause screening failures and whether unscreened patients are at increased risk of hazardous alcohol use.MethodsThis is a secondary analysis of a prospective study. From November 2012 to November 2013, all adult patients visiting a Dutch inner city ED were screened for hazardous alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption. Reasons for failure of screening were categorised as: (A) patient is unable to cooperate (due to illness or pain, decreased consciousness or incomprehension due to intoxication, psychiatric, cognitive or neurological disorder or language barrier), (B) healthcare professional forgot to ask, (C) patient refuses cooperation and (D) screening was recently performed (<6 months ago). Presence of risk factors for hazardous alcohol use was compared between screened and unscreened patients.ResultsOf the 28 019 ED patients, 18 310 (65%) were screened and 9709 (35%) were not. In 7150 patients staff forgot to screen, whereas 2559 patients were not screened due to patient factors (2340 being unable and 219 unwilling). Patients with any of these risk factors were less likely to be screened: male sex, alcohol-related visit, any intoxication, head injury, any kind of wound and major trauma. In multivariate analysis, all these risk factors were independently associated with not being screened. Patients with at least one risk factor for hazardous alcohol use were less likely to be screened. Highest prevalence of risk factors was found in patients unable or unwilling to cooperate.ConclusionPatients who do not undergo routine screening for alcohol use at triage in the ED have an increased risk for hazardous alcohol use. These data highlight the importance of screening patients, especially those initially unwilling or unable to cooperate, at a later stage. Show less
