An implementation science approach to geriatric screening in an emergency department

Abstract

Background: The Geriatric Emergency Department (ED) Guidelines recommend screening older adults during their ED visit for delirium, fall risk/safe mobility, and home safety needs. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) tool for preimplementation planning. Methods: The cross-sectional survey was conducted among ED nurses at an academic medical center. The survey was adapted from the CFIR Interview Guide Tool and consisted of 21 Likert scale questions based on four CFIR domains. Potential barriers identified by the survey were mapped to identify recommended implementation strategies using ERIC.Results: Forty-six of 160 potential participants (29%) responded. Intervention Characteristics: Nurses felt geriatric screening should be standard practice for all EDs (76.1% agreed some/very much) and that there was good evidence (67.4% agreed some/very much). Outer setting: The national and regional practices such as the existence of guidelines or similar practices in other hospitals were unknown to many (20.0%). Nurses did agree some/very much (64.4%) that the intervention was good for the hospital/health system. Inner Setting: 67.4% felt more staff or infrastructure and 63.0% felt more equipment were needed for the intervention. When asked to pick from a list of potential barriers, the most commonly chosen were motivational (I often do not remember (n = 27, 58.7%) and It is not a priority (n = 14, 30.4%)). The identified barriers were mapped using the ERIC tool to rate potential implementation strategies.Strategies to target culture change were identifying champions, improve adaptability, facilitate the nurses performing the intervention, and increase demand for the intervention.Conclusion: CFIR domains and ERIC tools are applicable to an ED intervention for older adults. This preimplementation process could be replicated in other EDs considering implementing geriatric screening.

Why does delirium continue to go unrecognized?

“…Their study builds on and confirms previous work that examined nursing barriers to delirium screening implementation [3]. In addition, Southerland et al undertook a survey that evaluated potential barriers to implementation of geriatric screening using the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementation Change tool [4]. In their study, they identified similar barriers but also described potential strategies to address them.…”

Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening

“…Incorporating delirium screenings into routine ED environments is challenging. 11,12 Optimizing information technology systems to support clinicians in performing geriatric screenings is an important consideration for their successful implementation. 11,13,14 Uptake of evidence-based guidelines for ED delirium screening has been limited.…”

Adapting Emergency Care for Persons Living With Dementia: Results of the Geriatric Emergency Care Applied Research Network Scoping Review and Consensus Conference

“…To create interventions with the optimal potential for scale-up via implementation science, future emergency medicine research including PLWD will need to investigate real-world settings with disruptive, pragmatic innovations. 21,22 Transforming geriatric emergency care for a cognitively frail population will require rational adaptations to research methods and more transparent inclusivity. A patient-centered focus on appropriate autonomy and maintaining functional capacity aligns with representative stakeholder's priorities.…”