Objectives: Older patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35 days of the index ED visit and to determine potential cost savings of this intervention.Methods: This was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3 days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8 days and 30 to 35 days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up.Results: A total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75 years (standard deviation [SD] AE 7.58 years). Intervention patients were more likely to follow up with medical providers within 5 days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p = 0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35 days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27%, respectively; p = 0.41). An economic analysis showed an estimated 70% chance that this intervention would reduce total costs. Conclusions:Telephone call follow-up of older patients discharged from the ED resulted in expedited follow-up for patients with their primary care physicians. Further study is warranted to determine if

A scripted telephone call from a trained nurse to an older adult after discharge from the ED did not reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.

BackgroundThe Otago Exercise Program (OEP) is an evidence-based fall prevention program developed, evaluated, and disseminated in New Zealand. The program was designed for delivery in the home by physical therapists (PTs). It was not known if American PTs would require additional training and resources to adopt the OEP. This article describes the process of translating the OEP for dissemination in the US. Processes included reviewing and piloting the New Zealand training materials to identify implementation challenges, updating training materials to be consistent with American physical therapy practices, piloting the updated training materials in an online format, and determining if the online format reached the target PT audience.Methods – Process ActivitiesThe New Zealand manual was reviewed by expert American PTs and a training webinar was piloted with 56 American PTs. Feedback suggested that the program itself was understood by PTs, but training materials required modification related to documentation and reimbursement policies. Additional content was developed and integrated into an online training module. The online training was piloted and then deemed adequate by seven PT subject matter experts. The online training was launched in March 2013. Demographic and practice data were collected to characterize the PTs attending the online training as well as perceived barriers and facilitators to implementation (n = 522). Perceived facilitators include the effectiveness of the OEP to facilitate adoption, but the lack of agency support, billing and reimbursement challenges pose a significant barrier to OEP implementation.ConclusionThe OEP required additional information to facilitate adoption by American PTs. Online training that specifically targets PTs appears to effectively reach the target audience and be well received by participants. More research is required to determine the impact of online training on a PT’s adoption and implementation of this material into their practice.

Objectives: Despite an increasing number of elderly emergency department (ED) patients, emergency medicine (EM) residency training lacks geriatric-specific curricula. The objective was to determine if a 1-year geriatric curriculum, designed for residents, would affect residents' attitudes, knowledge, and decision-making for older patients seen in the ED. Methods: The authors created a geriatric curriculum for EM residents composed of six lectures on the following topics: trauma, abdominal pain, transitions of care, medication management, iatrogenic injuries, and confusional states. A second component of the curriculum included seven high-fidelity simulation skills training sessions on aortic aneurysm, salicylate toxicity, drugs of abuse, infection from a posterior pressure ulcer, medication-induced elevated prothrombin time resulting in gastrointestinal bleeding, mesenteric ischemia, and myocardial infarction. Before and after completion of the curriculum, residents were assessed on attitudes toward caring for geriatric patients using a validated survey and knowledge of geriatric principals of care using a 35-question multiple choice test. To determine differences before and after the new curriculum was implemented, the paired t-test was performed on knowledge and attitude scores. ED records were also reviewed for frequency of chemical sedation and urinary catheter placement in patients aged 65 and over, both before and after the educational intervention , as a measure of appropriate decision-making. Appropriateness of urinary catheter placement was determined by two physician reviewers using criteria adapted from the Centers for Disease Control and Prevention indications for appropriate urinary catheter use. Reviewers met to adjudicate any disagreements about appropriateness. Fisher's exact test was used to examine differences in frequency of chemical sedation and urinary catheter placement. Results: Twenty-nine EM residents underwent the training. There was no measured change in attitudes. Knowledge improved from the pre-to posttest with average scores of 58.5 and 68.0%, respectively (p < 0.0001), among the 25 residents who completed both tests. There was no change in the percentage of elderly patients receiving chemical sedation and urinary catheters before and after the curriculum (5.4% vs. 4.5%, p = 0.47; and 7.4% vs. 5.9%, p = 0.3, respectively). The number of inappropriate urinary cathe-ters placed significantly decreased after the curriculum, from 8 of 49 to 1 of 47 (16.3% vs. 2.1%, p = 0.03). Conclusions: Geriatric educational curricula for EM residents may positively affect knowledge base and appropriate decision-making when working with older adults in the ED. These educational enhancements may place elderly patients at less risk of adverse outcomes. ACADEMIC EMERGENCY MEDICINE 2011; 18:S92-S96 ª