Diversity, Equity, and Inclusion: Considerations in the Geriatric Emergency Department Patient

Chary, Anita; Cameron-Comasco, Lauren; Shankar, K.; Samuels‐Kalow, Margaret

doi:10.1016/j.cger.2023.04.009

Cited by 3 publications

(1 citation statement)

References 44 publications

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“…The GEDA program may inadvertently magnify disparities in geriatric care and outcomes between sites with resources to achieve accreditation and those without. 31 This could also indicate that GEDA is more complex and less feasible in rural or poorly resourced EDs. Some of our participants highlighted how philanthropy facilitated their pursuit of accreditation, and this could be an important mechanism to facilitate GEDA implementation in resource‐poor sites.…”

Section: Discussionmentioning

confidence: 99%

Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Chary,

Bhananker,

Ramont

et al. 2024

JACEP Open

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ObjectivesImplementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences of implementing geriatric care processes in EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These EDs can provide a model for adopting and sustaining guidelines for evidence‐based geriatric care.MethodsWe performed qualitative interviews with geriatric ED nurse and physician leaders overseeing their ED's geriatric accreditation processes. The interview guide was based on the Consolidated Framework for Implementation Research (CFIR), a framework consisting of a comprehensive set of factors that impact implementation of evidence‐based interventions. We used inductive analysis to elucidate key themes from interviews and deductive analysis to map themes onto CFIR constructs.ResultsClinician leaders from 15 of 19 EDs that upgraded accreditation status by March 1, 2023 participated in interviews. Motivations to upgrade accreditation level centered on improving patient care (73%) and achieving recognition (56%). Rationales for choosing specific care processes were more commonly related to feasibility (40%) and ability to integrate the processes into the electronic health record (33%) than to site‐specific patient needs (20%). Several common experiences in implementation were identified: (1) financing from the larger health system or philanthropy was crucial; (2) translating the Geriatric ED Guidelines into clinical practice was challenging for clinician leaders; (3) motivational barriers existed among frontline ED staff; (4) longitudinal staff education was needed given frontline ED staff attrition and turnover; and (5) the electronic health record facilitated implementation of geriatric screenings.ConclusionsGeriatric ED accreditation involves significant time, resource allocation, and longitudinal staff commitment. EDs pursuing geriatric accreditation balance aspirations to improve patient care with resource availability to implement new care processes and competing priorities.

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Section: Discussionmentioning

confidence: 99%

Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Chary,

Bhananker,

Ramont

et al. 2024

JACEP Open

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Risk factors and risk stratification approaches for delirium screening: A Geriatric Emergency Department Guidelines 2.0 systematic review

Seidenfeld,

Lee,

Ragsdale

et al. 2024

Academic Emergency Medicine

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ObjectiveAs part of the Geriatric Emergency Department (ED) Guidelines 2.0 project, we conducted a systematic review to find risk factors or risk stratification approaches that can be used to identify subsets of older adults who may benefit from targeted ED delirium screening.MethodsAn electronic search strategy was developed with a medical librarian, conducted in April 2021 and November 2022. Full‐text studies of patients ≥65 years assessed for prevalent delirium in the ED were included. Risk of bias was assessed using the McMaster University Clarity Group tool. Outcomes measures pertained to the risk stratification method used. Due to heterogeneity of patient populations, risk stratification methods, and outcomes, a meta‐analysis was not conducted.ResultsOur search yielded 1878 unique citations, of which 13 were included. Six studies developed a novel delirium risk score with or without evaluation of specific risk factors, six studies evaluated specific risk factors only, and one study evaluated an existing nondelirium risk score for association with delirium. The most common risk factor was history of dementia, with odds ratios ranging from 3.3 (95% confidence interval [CI] 1.2–8.9) to 18.33 (95% CI 8.08–43.64). Other risk factors that were consistently associated with increased risk of delirium included older age, use of certain medications (such as antipsychotics, antidepressants, and opioids, among others), and functional impairments. Of the studies that developed novel risk scores, the reported area under the curve ranged from 0.77 to 0.90. Only two studies reported potential impact of the risk stratification tool on screening burden.ConclusionsThere is significant heterogeneity, but results suggest that factors such as dementia, age over 75, and functional impairments should be used to identify older adults who are at highest risk for ED delirium. No studies evaluated implementation of a risk stratification method for delirium screening or evaluated patient‐oriented outcomes.

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Bibliometric Study on Geriatric Emergencies: Intellectual Structure, Prominent Themes, and Future-Directing Topics

Turan Sönmez,

Tabur

2023

Med Sci Discov

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Objective: This study aims to identify the intellectual structure, prominent themes, and diseases associated with geriatric emergency care. Additionally, it seeks to establish research questions for future studies. Material and Methods: Co-citation and co-occurrence analyses were conducted for bibliometric evaluations. The Web of Science database was utilized. Diseases mentioned in 939 articles were identified through thematic coding analysis of abstracts and titles. Finally, questions for the future agenda were prepared. Bibliometric analyses were carried out using R-based Bibliometrix software. Results: Co-citation analysis revealed two main themes: "Adverse Outcomes in Elderly Post-Emergency Service, Delirium Identification, and Multidisciplinary Interventions" and "Diagnosis and Management of Cognitive Dysfunction in Elderly Emergency Department Patients." Co-occurrence analyses indicate that the literature clusters around key themes such as "risk and prevalence," "management and epidemiology," "physical performance," "elderly care and outcomes," "elderly and community," "survival and prognosis," and "stroke and related diseases." According to the list of diseases, the ten most frequently studied diseases in geriatric emergency articles are, in order, Cancer, Stroke, Dementia, Depression, Delirium, Alzheimer's, Carcinoma, Metabolic Syndrome, Type 2 Diabetes, and Heart Failure. Conclusion: Adopting a comprehensive approach is essential for improving older adults' quality of life and independenceHealthcare providers and decision-makers should take these findings into consideration, as they make significant contributions to the health and independence of the elderly population. Furthermore, questions for future research agendas have been formulated.

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Diversity, Equity, and Inclusion: Considerations in the Geriatric Emergency Department Patient

Cited by 3 publications

References 44 publications

Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Pragmatism and feasibility: A qualitative study of experiences implementing and upgrading care in geriatric emergency departments

Risk factors and risk stratification approaches for delirium screening: A Geriatric Emergency Department Guidelines 2.0 systematic review

Bibliometric Study on Geriatric Emergencies: Intellectual Structure, Prominent Themes, and Future-Directing Topics

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