Introduction. The geriatric patient with over 65 years of age is usually suffering from some chronic diseases that often have exacerbation. The family physician often has difficulty in the management of disease exacerbations of elderly patients: this is due to the patient's family and social problems either due to limited availability of home run laboratory tests and instrumental diagnostic investigations. Therefore doctor is often obliged to advise hospitalization. However there is a welfare mode called "home hospitalization" (HH), which allows the elderly patient being assisted by a doctor and nurses of the hospital department of geriatrics remaining in their own homes. Objective of the study is to evaluate the role of ultrasonography performed within 6 hours after the start of the HH and see if the doctor, after acquiring the ultrasound results, can manage more easily subsequent appropriate diagnostic investigations and the most appropriate therapy. Furthermore goal of the study is also to assess whether, by performing the ultrasound examination within 6 hours of admission, there is a reduction of the average length of stay and a reduction in spending on diagnostic tests and drugs. Materials and methods. Were compared two groups of 100 elderly patients with chronic diseases who have had an acute exacerbation. All patients, 120 women and 80 men, were admitted to the Geriatrics, 100 in the Department of Geriatrics at the hospital and 100 at home, with HH. The doctors and nurses of the geriatrics department attended all patients and those hospitalized in the hospital and those hospitalized at home. The diseases treated were: liver cirrhosis, abdominal colic, heart failure, exacerbation of chronic bronchitis, renal colic, acute retention of urine. In each group of 100 elderly patients, in 50% of patients ultrasonography was performed within 6 hours of admission. Results. The group of patients admitted at home (HH), for all diseases, has had a shorter average hospital stay of two days than patients hospitalized in geriatrics department. The group of patients in which the ultrasound within 6 hours of admission was performed, whether at home or in the hospital ward, had a shorter average hospital stay of three days compared to the patient group in which the ultrasound was performed within three days of admission. The number of diagnostic tests prescribed was 20% lower in the group of patients admitted at home, and was 30% lower in the group of patients in whom it was quickly performed the ultrasound examination. The cost for drugs was lower 20% in patients with hospitalization at home . In the group of patients with ultrasound within 6 hours the cost for drugs was lower by 30%. Patients who have had greater effectiveness and efficiency of care, after the rapid execution of ultrasound, had the following disorders: abdominal and renal colic, acute retention of urine, liver cirrhosis, heart failure with pleural effusion, pericardial effusion and abdominal, chronic bronchitis with exacerbation and pleural effusion. Conclusions. Our study has shown that if an ultrasound is performed within 6 hours of admission, both in hospital and at home, the elderly patient is treated with more appropriate procedures. The patient aged over 65 admitted at home also is treated more quickly and with less expense for diagnostic tests and drugs. The geriatric home hospitalization is therefore a useful and effective alternative to hospitalization in geriatrics department and will delight both patients and family members. Doctors who treat patients at home have to be experts in ultrasound and shall be familiar with the advantages and the limits of ultrasound examination in the elderly . It is therefore essential to organize appropriate teaching and learning programs in geriatric ultrasound both for family doctors and for doctors at the hospital. This strategy of teaching ultrasonography and this home care strategy (HH) allows to increase effectiveness and efficiency of care for elderly patients.
Use of ultrasound in Graduate Medical and Continuing Education , Patient Safety
