Standardized Screening and Assessment of Older Emergency Department Patients: A Survey of Implementation in Quebec

McCusker, Jane; Verdon, Josée; Veillette, Nathalie; Berg, Katherine; Emond, Tina; Belzile, Éric

doi:10.3138/g236-p856-815w-3863

Cited by 12 publications

(7 citation statements)

References 31 publications

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“…Barriers to implementation of standardized ED geriatric screening instruments include lack of resources and inadequate follow-up, misunderstanding the distinction between screening and assessment tools, and the need to adapt instruments to the local context. 126 In designing for implementation from the first stages of derivation, future investigators should contemplate the role of disruptive innovation in user-friendly, ED clinician-feasible instruments. 127 For example, one could use pad-based or smart phone technology to develop instruments that risk stratify patients in parallel with ongoing ED operations so as not to increase length of stay or overburden nurses and clinicians.…”

Section: Con Nue Tes Ngmentioning

confidence: 99%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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Objectives: A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.Methods: A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical testtreatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.Results: A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR-= 0.27) and nursing home placement (LR-= 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR-range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Conclusions: Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the r...

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Section: Con Nue Tes Ngmentioning

confidence: 99%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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“…, McCusker et al . ), but they have been shown to be suboptimal in predicting unplanned readmission in older hospitalised patients (Braes et al . , Carpenter et al .…”

Section: Introductionmentioning

confidence: 99%

“…time pressure, competing demands, lack of resources and knowledge and perceived irrelevance of screening in this critical care environment (McCusker et al . , Asomaning & Loftus , Tavender et al . ).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework

Kirk

Sivertsen

Petersen

et al. 2016

Journal of Clinical Nursing

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Aim. The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. Background. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. Design. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. Methods. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Results. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. Conclusions. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. Relevance for clinical practice. The results show that different cultures exist in the same local context and influence the perception of barriers and facilitators difWhat does this paper contribute to the wider global community?• Culture forms professional role and identity, actions and sense making and provides different ways to perceive barriers and facilitators linked to new screening tools.• This emphasises the importance of understanding the local culture before any implementation strategy linked to screening tools is planned.• As researchers, we have to understand how new tools makes sense in a cultural context before planning any implementation strategies. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…[9,11,35,36] Of the ED frequent users in this study, seventy-two percent were admitted within thirty days of a previous ED visit, and eighty-seven percent had at least two hospital admissions within a 6-month period from the previous ED visit. Therefore, based on these findings, 30-day readmission from a prior ED visit or 2 hospital admissions within 6 months of a prior ED visit are risk factors for frequent use of the Emergency Department by older adults.…”

Section: Discussionmentioning

confidence: 78%

Risk factors for frequent users of the emergency department among adults aged 55 and older

Hays

Penprase

Kridli

2018

JNEP

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Introduction: Excessive use of the emergency department (ED) is a major source of healthcare expenditure. ED frequent users, have been identified as a major contributing factor to a disporportionate amount of ED visits and costs, making up 20% to 30% of all annual visits. The aim of the study was to identify risk factors that place adults age 55 and older at risk for frequent ED use. Methods: The Transitional Care Model (TCM): Hospital Discharge Screening Criteria for High Risk Older Adults was used to identify risk factors for frequent use of ED services in adults 55 and older. Results and conclusions: A third of the sample (33%) had active behavioral and/or psychiatric issues. A majority of the sample (87%) had two or more hospitalizations within 6 months of a prior ED visit, and seventy-two percent were hospitalized within thirty days of an Emergency Department visit. Almost 70% had at least 1 chronic diagnosis of diabetes (41.5%), heart failure (35.8%), or COPD (28%). Most patients were between ages 70-85 years old and risk factors for ED frequent use included 4 or more coexisting health conditions, 6 or more prescription medications, previous hospital admissions, active behavioral and/or psychiatric issues. Identifying older adults at high risk for ED frequent use may provide earlier interventions and less reliance on ED use for care and treatment of chronic disorders.

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Standardized Screening and Assessment of Older Emergency Department Patients: A Survey of Implementation in Quebec

Cited by 12 publications

References 31 publications

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework

Risk factors for frequent users of the emergency department among adults aged 55 and older

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