Performance of the interRAI ED Screener for Risk-Screening in Older Adults Accessing Paramedic Services

Abstract

Background 
 Paramedics respond to a significant number of non-emergency calls generated by older adults each year. Paramedics routinely assess and screen older adults to determine risk level and need for additional follow-up. This project implemented the inter­RAI ED Screener into routine care to determine whether the screener and resulting Assessment Urgency Algorithm (AUA) score is useful in predicting adverse outcomes.
 Methods 
 We conducted a population-based retrospective study using administrative health data for patients aged 65+ assessed by paramedics from July 2016 to February 2017. Patients were assigned an AUA score and classified into three risk categor­ies. Outcome data including hospitalizations, Emergency Department (ED) visits, home care status, and survival were collected and compared across AUA risk categories using descriptive and analytical statistics.
 Results 
 Of the 2,801 patients screened, 31.9% were classified as high risk, 23.6% as moderate risk, and 44.6% as low risk. Patients who scored in the highest risk category were found to have longer hospital stays, and were more likely to require home care (p<.0001). The AUA risk category also predicted survival (p<.001).
 Conclusions 
 The AUA predicted multiple adverse outcomes in this popula­tion. Use of the AUA by paramedics may aid in earlier identifi­cation of those in need of additional intervention and services.

Examining the utility and accuracy of the interRAI Emergency Department Screener in identifying high‐risk older emergency department patients: A Canadian multiprovince prospective cohort study

“… 29 , 30 The interRAI ED Screener has also been used in the prehospital setting, where it was predictive of the need for hospitalization from the ED, the need for home care services after discharge, and mortality in older ED patients transported by paramedics. 18 …”

“…In addition, the interRAI ED Screener has shown to be useful in complex interventions geared toward improving geriatric models of care and shared decision making between high‐risk patients and ED clinicians 29,30 . The interRAI ED Screener has also been used in the prehospital setting, where it was predictive of the need for hospitalization from the ED, the need for home care services after discharge, and mortality in older ED patients transported by paramedics 18 …”

“…29,30 The interRAI ED Screener has also been used in the prehospital setting, where it was predictive of the need for hospitalization from the ED, the need for home care services after discharge, and mortality in older ED patients transported by paramedics. 18 The interRAI ED Screener fosters system integration by providing a common measurement approach to identify the need for a comprehensive assessment used in other health sectors. The Assessment Urgency Algorithm is widely used by home care programs in Canada as a basis for intake screening.…”

“…Prior work has validated the prognostic utility of the Assessment Urgency Algorithm and its association with mortality, hospital admissions, lengthy hospital stays, and the need for long‐term care services (ie, nursing or retirement home placement) in medically complex older ED and home‐care patients. 17 , 18 , 19 The Assessment Urgency Algorithm is readily available for public and hospital use via the interRAI ED Screener, a free mobile application that can be downloaded on mobile phones and tablets ( www.interRAI.org ).…”