Experiences with and attitudes towards geriatric screening among older emergency department patients: a qualitative study

Blomaard, Laura C.; Olthof, Mareline; Meuleman, Yvette; Groot, Bas de; Gussekloo, Jacobijn; Mooijaart, Simon P.

doi:10.1186/s12877-021-02144-7

Cited by 9 publications

(2 citation statements)

References 29 publications

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“…Thirty-two interventions described comprehensive assessment and multifaceted care for older adults in the ED (Table 1 ); twenty-one studies aimed to improve system performance by reducing avoidable hospital admissions and/or LOS and/or improve ED flow [ 30 – 50 ]; five aimed to improve patient outcomes [ 51 – 55 ]; five aimed to improve patient experience [ 56 – 60 ]; and one aimed to improve staff experience [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

Strategies to improve care for older adults who present to the emergency department: a systematic review

Testa,

Richardson,

Cheek

et al. 2024

BMC Health Serv Res

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Background The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. Methods A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. Results Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. Conclusion It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication.

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Section: Resultsmentioning

confidence: 99%

Strategies to improve care for older adults who present to the emergency department: a systematic review

Testa,

Richardson,

Cheek

et al. 2024

BMC Health Serv Res

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“…Screening and prioritizing older people, to ensure that they receive the nursing care they need, are warranted. Also, older people are positive regarding frailty screening to detect risks; they believe this could contribute to more holistic care (Blomaard et al, 2021). Furthermore, the findings show that frailty is often assessed based on local routines and non‐established instruments, indicating a lack of evidence‐based care, which has been identified as having a negative impact on patient outcome, patient participation and cost‐effectiveness (Spruce, 2015), and may also pose a challenge to equal care.…”

Section: Discussionmentioning

confidence: 99%

Fundamental nursing actions for frail older people in the emergency department: A national cross‐sectional survey and a qualitative analysis of practice guidelines

Ekermo

Ronnås

Athlin

2023

Journal of Advanced Nursing

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Aims To map how frailty among older people is assessed at Swedish emergency departments and to describe fundamental nursing care actions for these patients. Design Descriptive national survey and a qualitative analysis of text. Methods A majority (82%, n = 54) of the Swedish hospital‐based emergency departments for adults were included, representing all six healthcare regions. An online survey was used to collect data, together with submitted local practice guidelines for older people at the emergency departments. Data were collected during February–October 2021. Descriptive and comparative statistics were performed together with a deductive content analysis framed by the Fundamentals of Care framework. Results Sixty‐five per cent (35 of 54) of the emergency departments identified frailty, with less than half of them using an established assessment instrument. Twenty‐eight (52%) of the emergency departments have practice guidelines containing fundamental nursing actions for the care of frail older people. The majority of nursing actions in the practice guidelines were related to patients' physical care needs (91%), followed by psychosocial care needs (9%). No actions could be identified as relational actions (0%) according to the Fundamentals of Care framework. Conclusion Many Swedish emergency departments identify frail older people, but they use a range of different assessment instruments. While practice guidelines directing fundamental nursing actions for frail older people are often in place, a holistic, person‐centred view addressing the patient's physical, psychosocial and relational care needs is missing. Impact The population is growing older, and more people are needing more complex hospital care. Frail older people have an increased risk of negative outcomes. The use of a variety of assessment instruments for frailty may pose a challenge to equal care. To ensure a holistic, person‐centred view of frail older people, the Fundamentals of Care framework can be used in developing and reviewing practice guidelines. Patient or Public Contribution Clinicians and non‐health professionals were invited to review the survey to ensure face and content validity.

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Implementation of Prediction Models in the Emergency Department from an Implementation Science Perspective—Determinants, Outcomes, and Real-World Impact: A Scoping Review

Chan¹,

Lee²,

Ong³

et al. 2023

Annals of Emergency Medicine

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Experiences with and attitudes towards geriatric screening among older emergency department patients: a qualitative study

Cited by 9 publications

References 29 publications

Strategies to improve care for older adults who present to the emergency department: a systematic review

Strategies to improve care for older adults who present to the emergency department: a systematic review

Fundamental nursing actions for frail older people in the emergency department: A national cross‐sectional survey and a qualitative analysis of practice guidelines

Implementation of Prediction Models in the Emergency Department from an Implementation Science Perspective—Determinants, Outcomes, and Real-World Impact: A Scoping Review

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