Association of a geriatric emergency department program with healthcare outcomes among veterans

Huded, Jill M.; Lee, Albert; Song, Sunah; McQuown, Colleen M; Wilson, Brigid; Smith, Todd I.

doi:10.1111/jgs.17572

Cited by 19 publications

(28 citation statements)

References 45 publications

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“…13,14 Success of geriatric ED programs using a screening model in which they identify high risk older adults, then provide additional screening and care coordination by geriatric emergency medicine trained champions provides an innovative framework for integrating the 4Ms into ED care that does not rely on either the inpatient or outpatient Institute for Healthcare Improvement framework. 7,8,15 In 2020, the VA Offices of Emergency Medicine and Geriatrics & Extended Care launched 20 VA facilities toward a goal of geriatric ED accreditation as phase one of a three-phase initiative to promote geriatric emergency medicine across the VA enterprise. 16 This phased approach allowed the VA to identify implementation barriers and allow for collaboration across VA service lines.…”

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confidence: 99%

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

McQuown

Snell

Abbate

et al. 2022

Health Services Research

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Objective To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age‐Friendly Health Systems via the emergency department (ED) follow‐up home visits supported by telehealth. Data Sources and Study Setting Data sources were a pre‐implementation site survey and pilot phase individual‐level patient data from six US Department of Veterans Affairs (VA) EDs. Study Design A pre‐implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high‐risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow‐up telephone, or home visits. During the follow‐up visit, ICTs identified “what matters,” performed geriatric screens aligned with Age‐Friendly Health Systems, observed home safety risks, assisted with video telehealth check‐ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. Data Collection/Extraction Methods Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May–October 2021. Principle Findings Site surveys showed none of the EDs had a formalized way of identifying the 4 M “what matters.” During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow‐up. Conclusions A post‐ED follow‐up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

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confidence: 99%

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

McQuown

Snell

Abbate

et al. 2022

Health Services Research

Self Cite

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“…ISAR is used typically as step 1 of a 2-step intervention, in which it is used to target patients for a step 2 clinical assessment of geriatric problems requiring tailored intervention. Interventions targeted in this way have demonstrated positive effects on functional decline and other outcomes, including cost-effective use of resources [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Based on our correspondence with ISAR users, the majority are using the ISAR-R (list of users available upon request). For example, the ISAR-R has been adopted for use in the U.S. Veterans Affairs hospitals, including the GERI-VET program [14]. Note that this latter program used the ISAR-R although the original ISAR was referenced instead (personal communication, Dr. Huded).…”

Section: Introductionmentioning

confidence: 99%

The Revised Identification of Seniors At Risk screening tool predicts readmission in older hospitalized patients: a cohort study

et al. 2022

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Background The Identification of Seniors at Risk (ISAR) screening tool is a widely-used risk stratification tool for older adults in the emergency department (ED). Few studies have investigated the use of ISAR to predict outcomes of hospitalized patients. To improve usability a revised version of ISAR (ISAR-R), was developed in a quality improvement project. The ISAR-R is also widely used, although never formally validated. To address these two gaps in knowledge, we aimed to assess the ability of the ISAR-R to predict readmission in a cohort of older adults who were hospitalized (admitted from the ED) and discharged home. Methods This was a secondary analysis of data collected in a pre-post evaluation of a patient discharge education tool. Participants were patients aged 65 and older, admitted to hospital via the ED of two general community hospitals, and discharged home from the medical and geriatric units of these hospitals. Patients (or family caregivers for patients with mental or physical impairment) were recruited during their admission. The ISAR-R was administered as part of a short in-hospital interview. Providers were blinded to ISAR-R scores. Among patients discharged home, 90-day readmissions were extracted from hospital administrative data. The primary metrics of interest were sensitivity and negative predictive value. The Area Under the Curve (AUC) was also computed as an overall measure of performance. Results Of 711 attempted recruitments, 496 accepted, and ISAR-R was completed for 485. Of these 386 patients were discharged home with a complete ISAR-R, the 90-day readmission rate was 24.9%; the AUC was 0.63 (95% CI 0.57,0.69). Sensitivity and negative predictive value at the recommended cut-point of 2 + were 81% and 87%, respectively. Specificity was low (40%). Conclusions The ISAR-R tool is a potentially useful risk stratification tool to predict patients at increased risk of readmission. Its high values of sensitivity and negative predictive value at a cut-point of 2 + make it suitable for rapid screening of patients to identify those suitable for assessment by a clinical geriatric team, who can identify those with geriatric problems requiring further treatment, education, and follow-up to reduce the risk of readmission.

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“…The highest level must have case management and all 4 of those disciplines. 23 , 25 Geriatric assessments in accredited geriatric EDs may be performed by specially trained emergency nurses 26 , 27 , 28 , 29 , 30 or former military medics and corpsmen, 31 , 32 or in a geriatric consultation model with geriatric advanced care practitioners (APPs) 33 , 34 or physicians. 35 , 36 Studies evaluating the impact of these programs typically focused on health care use and have demonstrated that geriatric care models may decrease hospital admissions at the index ED visit, 29 , 31 , 34 , 37 hospital length of stay, 30‐day hospital readmissions 28 and overall Medicare costs at 30 and 60 days after the ED visit.…”

Section: Introductionmentioning

confidence: 99%

“… 23 , 25 Geriatric assessments in accredited geriatric EDs may be performed by specially trained emergency nurses 26 , 27 , 28 , 29 , 30 or former military medics and corpsmen, 31 , 32 or in a geriatric consultation model with geriatric advanced care practitioners (APPs) 33 , 34 or physicians. 35 , 36 Studies evaluating the impact of these programs typically focused on health care use and have demonstrated that geriatric care models may decrease hospital admissions at the index ED visit, 29 , 31 , 34 , 37 hospital length of stay, 30‐day hospital readmissions 28 and overall Medicare costs at 30 and 60 days after the ED visit. 38 Few studies, however, have evaluated the impact of geriatric EDs or specialized geriatric staffing models on patient‐oriented outcomes, 39 though there is evidence that consultations by geriatric nurse practitioners may improve patient experience and documentation of advance care directives.…”

Section: Introductionmentioning

confidence: 99%

Developing a novel integrated geriatric palliative care consultation program for the emergency department

et al. 2022

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With the aging of our population, older adults are living longer with multiple chronic conditions, frailty, and life‐limiting illnesses, which creates specific challenges for emergency departments (EDs). Older adults and those with serious illnesses have high rates of ED use and hospitalization, and the emergency care they receive may be discordant with their goals and values. In response, new models of care delivery have begun to emerge to address both geriatric and palliative care needs in the ED. However, these programs are typically siloed from one another despite significant overlap. To develop a new combined model, we assembled stakeholders and thought leaders at the intersection of emergency medicine, palliative care, and geriatrics and used a consensus process to define elements of an ideal model of a combined palliative care and geriatric intervention in the ED. This article provides a brief history of geriatric and palliative care integration in EDs and presents the integrated geriatric and palliative care model developed.

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Association of a geriatric emergency department program with healthcare outcomes among veterans

Cited by 19 publications

References 45 publications

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

The Revised Identification of Seniors At Risk screening tool predicts readmission in older hospitalized patients: a cohort study

Developing a novel integrated geriatric palliative care consultation program for the emergency department

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