Discharge planning for elderly patients.

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.

Accuracy of tympanic temperature readings in children under 6 years of age.

PURPOSE: Infrared tympanic thermometry (ITT) is increasingly used as a convenient, noninvasive assessment method for febrile children. However, the accuracy of ITT for children has been questioned, particularly in relation to specificity and sensitivity. This study was designed to (a) determine the correlation and extent of agreement between rectal temperature (RT) readings obtained by electronic thermometer and ear-based temperature readings obtained by ITT, and (b) determine the accuracy of detecting fever in children under 6 years of age. METHODS: This correlational study used a sample of 241 paired ear and rectal temperatures obtained in the emergency department (ED) of a 920-bed regional hospital. All children under the age of 6 years who routinely received a rectal temperature measurement were eligible to participate. According to the ED protocol, rectal temperatures were obtained on all patients less than 3 years or patients 3-6 years that presented with a complaint of fever. For the study, tympanic measurements were also taken. RESULTS: Correlation between rectal and tympanic temperature readings was statistically significant (r = 0.84, p < .001). The mean difference between rectal and tympanic temperatures was -0.60 degrees C. Threshold-adjusted accuracy in screening for fever was determined by sensitivity (80%), specificity (85%), positive predictive value (87%), and negative predictive value (85%). CONCLUSIONS: Sensitivity, specificity, positive predictive value, and negative predictive value are unacceptably low and the number of children with fever who would be missed by screening with a tympanic thermometer is unacceptable. Findings of this study do not support the use of tympanic thermometers to detect fever in children under 6 years of age.