Geriatric consultation service in emergency department: how does it work?

Yuen, Terry Man Yue; Lee, Larry Lap Yip; Or, Ikea Lai Chun; Yeung, Kwai Lin; Chan, Jimmy; Chui, Catherine Pui Yuk; Kun, Emily W.

doi:10.1136/emermed-2012-201139

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…Research about CGA at the ED is scarce and considerable heterogeneity is observed between reported interventions. Descriptive research has demonstrated the feasibility of CGA interventions, and documented a large range of undetected care needs [ 31 - 34 ]. To the authors’ knowledge only three randomized controlled trials [ 35 - 37 ] and two pre-post implementation studies [ 29 , 38 ] reported outcomes of a geriatric intervention at the ED.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study

et al. 2015

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BackgroundPatients aged 75 years and older represent 12% of the overall emergency department (ED) population, and this proportion will increase over the next decades. Many of the discharged patients suffer an unplanned readmission in the immediate and midterm post-discharge period, suggesting under recognition of psychosocial, cognitive and medical problems. The aim of this study was to compare the characteristics of older patients admitted and discharged from the ED and to determine independent predictors for ED readmission 1 month and 3 months after ED discharge based on comprehensive geriatric assessment (CGA).MethodsCohort study in a Belgian university hospital. A CGA, including demographic and medical data (e.g. reason for admission, comorbidity, number of medications), functional (e.g. activities of daily living, falls), mental (i.e. cognition, dementia, delirium), and nutritional status, and pain, was performed in 442 ED patients aged 75 years or older.ResultsPatients discharged from the ED (n = 117, 26.5%) were significantly less dependent for ADL, mobility, shopping and finances compared with hospitalised patients. Hospitalised patients (n = 325, 73.5%) were significantly more at risk for having nutritional problems, had a higher comorbidity index, and a lower cognitive status compared with those discharged. Ninety-seven patients (82.9%) were discharged home from the ED. Of the latter, 18 (18.6%) and 28 patients (28.9%) suffered an ED readmission within 1 and 3 months, respectively. At one month post-discharge, nursing care at home, meals on wheels, and risk for depression; and at 3 months post-discharge previous hospitalisation in the last 3 months, physiotherapy and meals on wheels were found to be independent predictors for ED readmission, respectively.ConclusionsThis study observed a geriatric risk profile in older adults at the ED and a high readmission rate of those discharged, and suggests the potential value of CGA in identifying older patients at high risk for ED readmission.

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Section: Discussionmentioning

confidence: 99%

Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study

et al. 2015

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“…37 When possible, previously validated survey instruments are preferable, 38 but for our objectives, no such instrument exists. Therefore, our survey instrument was developed by a detailed review of existing research focused on ED interventions to improve geriatric adult emergency care, 5,6,13,15,20,25,26,32,34,35,[39][40][41][42][43][44][45][46] as well as discussions with a multidisciplinary collaboration of representatives from SAEM, ACEP, the American Geriatrics Society, and the Emergency Nurses Association. This collaboration continues to develop geriatric ED infrastructure, personnel, protocol, and educational guidelines.…”

Section: Survey Content and Administrationmentioning

confidence: 99%

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

Hogan

Olade

Carpenter

2014

Academic Emergency Medicine

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Background: The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States.

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“…The national multispecialty Geriatric ED Guidelines recognize this problem and endorse Multidisciplinary Geriatric Assessment for all high-risk ED patients [11]. Multidisciplinary assessment by geriatricians, case managers, pharmacists, and physical therapists (PTs) in the ED can identify geriatric syndromes and address needs, which leads to decreased unnecessary hospitalizations [12][13][14][15][16][17][18]. Studies of multidisciplinary assessment in the ED show measurable benefits with decreases in hospitalizations, intensive care unit admissions, ED revisits, and functional decline at 6 months [12,15,17,[19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

“…Multidisciplinary assessment by geriatricians, case managers, pharmacists, and physical therapists (PTs) in the ED can identify geriatric syndromes and address needs, which leads to decreased unnecessary hospitalizations [ 12 – 18 ]. Studies of multidisciplinary assessment in the ED show measurable benefits with decreases in hospitalizations, intensive care unit admissions, ED revisits, and functional decline at 6 months [ 12 , 15 , 17 , 19 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

Southerland

Mion

Moffatt-Bruce

et al. 2020

Implement Sci Commun

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Background: Older adults in the emergency department (ED) are at high risk for functional decline, unrecognized delirium, falls, and medication interactions. Holistic assessment by a multidisciplinary team in the ED decreases these adverse outcomes and decreases admissions, but there are many barriers to incorporating this type of care during the ED visit. Methods: This is a hybrid type II effectiveness-implementation study using a pre-/post-cohort design (n = 380) at a tertiary care academic ED with an ED observation unit (Obs Unit). The intervention is a two-step protocol of (step 1) ED nurses screening adult patients ≥ 65 years old for geriatric needs using the Delirium Triage Screen, 4-Stage Balance Test, and the Identifying Seniors at Risk score. Patients who have geriatric needs identified by this screening but who do not meet hospital admission criteria will (step 2) be placed in the Obs Unit for multidisciplinary geriatric assessment by the hospital's geriatric consultation team, physical therapists, occupational therapists, pharmacists, and/or case managers. Not all patients may require all elements of the multidisciplinary geriatric assessment. The Consolidated Framework for Implementation Research: Care Transitions Framework was used to identify barriers to implementation. Lean Six Sigma processes will be used to overcome these identified barriers with the goal of achieving geriatric screening rates of > 80%. Implementation success and associated factors will be reported. For the effectiveness aim, pre-/post-cohorts of adults ≥ 65 years old cared for in the Obs Unit will be followed for 90 days postED visit (n = 150 pre and 230 post). The primary outcome is the prevention of functional decline. Secondary outcomes include health-related quality of life, new geriatric syndromes identified, new services provided, and Obs Unit metrics such as length of stay and admission rates.

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Geriatric consultation service in emergency department: how does it work?

Abstract: Programme 'We Care' provided comprehensive geriatric assessment to suitable geriatric patients, resulting in an effective reduction of acute geriatric hospital admission.

Cited by 12 publications

References 8 publications

Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study

Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

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