Older peoples’ experience of accessing emergency care

Considine, Julie; Smith, Robyn; Weiland, Tracey J; Gannon, John; Behm, Christine; Wellington, Peita; McCarthy, Sally

doi:10.1016/j.aenj.2010.05.001

Cited by 29 publications

(17 citation statements)

References 45 publications

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“…(7) Better access is made to pathology and diagnostic and treatment equipment in RACFs, for example, use of mobile services (Ouslander et al, 2010;Young et al, 2010). (8) EDs should be better designed to accommodate older people in terms of environment and type of care and services provided (Considine et al, 2010). Alternative triage and waiting processes could enhance the patient journey and be better suited to the needs of elderly patients (Considine et al, 2010;Nolan, 2009).…”

Section: Methodsmentioning

confidence: 99%

“…(8) EDs should be better designed to accommodate older people in terms of environment and type of care and services provided (Considine et al, 2010). Alternative triage and waiting processes could enhance the patient journey and be better suited to the needs of elderly patients (Considine et al, 2010;Nolan, 2009). Additionally, communication aids should be provided to older people when they are in ED (Nolan, 2009).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

O’Connell

Hawkins²,

Considine³

et al. 2013

Contemporary Nurse

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This research aimed to describe the number and type of residents admitted to emergency departments (EDs) over 2 years; and to explore nurses' perceptions of the reasons why residential aged care facility (RACF) residents are referred to EDs. The research objective was addressed in a retrospective exploratory study using data on admissions to EDs from RACFs (N = 3,094) at the participating organisation over a 2-year period, and interview data on seven RACF and four ED nurses' perceptions of the issues involved. Most residents presenting at EDs required urgent medical attention. Major themes identified by RACF and ED nurses included issues related to staff competency, availability of general practitioners, lack of equipment in RACFs, residents and family members requesting referrals, communication difficulties, and poor attitudes towards RACF staff. There is a need to use strategies to detect residents whose conditions are deteriorating and treat them promptly in RACFs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

O’Connell

Hawkins²,

Considine³

et al. 2013

Contemporary Nurse

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“…In a systematic review of older persons' presentations to ED, older age and living alone were identified as risk factors associated with increased presentations (Aminzadeh & Dalziel, 2002). One qualitative study found that older people and their families were reluctant to access ED but believed it was important to the older person's wellbeing (Considine et al, 2010). Furthermore, in a review of the literature, Langer et al (2013) found that socially and economically marginal older people logically viewed unscheduled care, such as ED presentations, as providing access to health services that are not otherwise available.…”

Section: Literature Reviewmentioning

confidence: 99%

Older persons who re-present to the Emergency Department: An observational study

et al. 2017

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Background: Models of emergent care evolve in response to an ageing population. The Medical Assessment Unit (MAU) receives patients from the Emergency Department (ED) for up to 48 hours to facilitate assessment, care and treatment before discharge home or to another inpatient unit. Aim: To describe the clinical and social characteristics of older people who had a stay in the MAU and then represent to the ED within 28 days of discharge from hospital. Methods: A retrospective observational study design was used. Data were extracted from electronic medical records of older people who represented to two public teaching hospital EDs in Queensland, Australia, over a two-week period in 2014. Findings: There were 78 older people who made 84 representations. The average age was 79 years; average number of co-morbidities was seven (range 1-18); almost one-quarter (23%) lived alone; more (63%) were female; half (58%) were married; and one-fifth (20%) had some form of cognitive impairment. Of those who represented with the same diagnosis, 46% had cardio-respiratory conditions. One-quarter (28%) of the re-presenters had a discharge summary from the last admission. Discussion: Most of the re-presenters in this study had cardio-respiratory conditions. While a discharge summary was available, it was not consistently completed, raising the importance of discharge summaries as part of continuity across services for older people. Conclusion: How the ED, MAU and primary health services are coordinated bears further investigation. Research into the value of coordination roles, such as nurse navigators, for older people representing to ED is recommended.

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“…Older people living in RACFs frequently experience cognitive impairment, polypharmacy and other complex medical comorbidities . Despite these complexities, management of the frail older adult continues to be caught up in the ‘one size fits all’ model of care currently seen in many EDs . This often leads to unnecessary invasive investigations, high rates of admission and re‐admission, delayed and fragmented care and longer ED LoS .…”

Section: Introductionmentioning

confidence: 99%

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

Marsden

Taylor

Wallis

et al. 2019

Emerg Medicine Australasia

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Objective: As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. Methods: GEDI is a nurse-led, physician-championed, innovative model delivered by advanced practice nurses with expertise in gerontology. This quasi-experimental pragmatic study compared outcomes for RACF residents who presented to a regional Queensland ED during three time periods: pre-GEDI, interim GEDI and post-GEDI implementation of the GEDI model. Outcomes included disposition, ED length of stay, ED representation and mortality. Results: A significant increase in the likelihood of discharge from ED (hazard ratio 1.15, 95% confidence interval 1.05-1.26) and reductions in ED length of stay (hazard ratio 1.49, 95% confidence interval 1.24-1.78) were evident for RACF residents following the implementation of the GEDI intervention. There were no differences in mortality, ED re-presentation or in-hospital length of stay between the three time periods. Conclusion: There is a paucity of evidence to support the implementation of nurse-led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents. Key findings• The GEDI is a physicianchampioned, nurse-led model designed to improve care and reduce unnecessary hospitalisation of frail older adults. • The GEDI model decreases the ED length of stay for RACF residents. • The GEDI model increased the likelihood of safe ED discharge for RACF residents.

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Older peoples’ experience of accessing emergency care

Cited by 29 publications

References 45 publications

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp

Older persons who re-present to the Emergency Department: An observational study

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

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