Circumstances of Patients with Amyotrophic Lateral Sclerosis Transferred to Other Hospitals after Emergency Hospitalization and Challenges in Post-Discharge Support

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  • 筋萎縮性側索硬化症患者の予定外入院から退院までの状況と支援課題
  • キン イシュクセイ ソクサク コウカショウ カンジャ ノ ヨテイ ガイ ニュウイン カラ タイイン マデ ノ ジョウキョウ ト シエン カダイ

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Abstract

The purpose of this study was to elucidate the circumstances of patients with amyotrophic lateral sclerosis who were emergently admitted to hospital and to examine problems associated with discharge and transfer. We reviewed medical records for 3 years and identified 4 home discharged patients and 8 hospital transfer patients who had been urgently admitted to the neurology ward of Hospital A. Mean hospital stay was 77 days. All patients received 24-h noninvasive positive pressure ventilation immediately after hospitalization. After a mean 31 days of hospitalization, patients chose medical treatments and/or treatment facilities. Three patients changed to tracheostomy positive pressure ventilation and 2 patients opted for tracheostomy. Four patients had disagreements with their families and needed time to resolve their differences. Between 1 to 6 hospitals were asked to accept each patient for transfer. Decisionmaking about initiation of medical treatment for respiratory failure needs to done in the early stages of illness. Healthcare providers need cooperation between in-hospital and community services and must demonstrate excellent assessment skills to recognize the progression of illness and the patient’s acceptance of illness. In addition, it is essential that healthcare providers possess special support skills when patients are transferred from intermediate institutions to home care.

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