Geneesmiddelgerelateerde SEH-bezoeken zonder opname bij ouderen

Background Research showed that 10% of acute hospital admissions in the elderly population are due to medication; roughly half of them are preventable. The Dutch guideline Polypharmacy in elderly people addendum secondary care, recommends hospital physicians to check whether a hospital admission of an elderly person with polypharmacy is due to adverse drug events (ADEs) on the basis of a trigger list. Little is known about the prevalence of ADEs in patients who go home after a visit to the emergency department (ED). Objective Primary objectives were to determine the percentage possible drugrelated ED visits and the percentage possible preventable drugrelated ED visits of patients that visit the ED, but who are not admitted to the hospital. Secondary objectives were to study the prevalence of adjustments to risk medication within three months and revisiting the ED with the same cause within six months. Design We conducted a retrospective observational descriptive cohort study. Methods Patients (? 70 years) that visited the ED without subsequent hospital admission were included. For all visits we determined if these were positive for a trigger according to the trigger list from the directive Polypharmacy in elderly people addendum secondary care. For all positive triggers current medication was obtained. Results 536 ED visits were included over a study period of eight weeks. Half of these visits were positive for a trigger. Falls or fall riskassociated triggers were the most frequent. For 174 patients with risk medication causality was assessed: 12% were probable, 60% possible, and 28% unlikely causal. For all 125 probable or possible causal visitations preventability was assessed: 12% were preventable, 53% possibly preventable, and 34% not preventable. Most used causal risk medications were betablocking agents, ACE inhibitors, and antidepressants. Of all patients with a possible preventable ED visit, 12% revisited the ED within six months due to the same cause. Conclusion In half of the ED visits without admission for which a possible related ADE was found, falls and fall risk associated events were the most frequently found triggers. Medication was a potential cause for 23% of all ED visits without admission, and 15,5% of these EDvisits were possible preventable.