The impact of geriatric focused nurse assessment and intervention in the emergency department: A systematic review

Malik, M.; Moore, Zena; Patton, Declan; O’Connor, Tom; Nugent, Linda

doi:10.1016/j.ienj.2018.01.008

Cited by 20 publications

(34 citation statements)

References 32 publications

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“…Hospitalizations were also slightly increased among individuals who received specialist geriatric assessment before discharge. One systematic review by Malika et al and an RCT by Edmans et al found that geriatric-focused nursing assessment and interventions did not have a statistical impact on hospitalization, readmissions, length of hospital stay and ED revisits [94,95].…”

Section: Resultsmentioning

confidence: 99%

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Coffey

Leahy‐Warren

Savage

et al. 2019

IJERPH

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Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

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Section: Resultsmentioning

confidence: 99%

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Coffey

Leahy‐Warren

Savage

et al. 2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…Reviews of ED interventions were organised into four evidence clusters: discharge intervention reviews (11,15,18,19,21), staff-focused reviews (13,14,17,20,23), population focused reviews (22,24), and intervention component reviews (12,16,24). Only 5 of the 15 reviews reported interventions delivered wholly within the ED -the remainder were continued into other settings.…”

Section: Intervention Classificationmentioning

confidence: 99%

“…Malik et al (20) reported three different types of nurse intervention: assessment using risk screening, CGA, and nurse-led case and discharge management. This meta-analysis of nine studies found that nursing interventions did not have a significant statistical impact on any of four outcomes (hospitalisation, readmissions, length of hospital stay and ED revisits).…”

Section: Staff-focused Reviewsmentioning

confidence: 99%

Improving outcomes for older people in the emergency department: a review of reviews

et al. 2020

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BackgroundThere has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people’s needs. The aim of this review was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area.MethodsA review of reviews, reporting interventions for older people, either initiated or wholly delivered within the ED.ResultsA total of 15 review articles describing 83 primary studies met our content and reporting standards criteria. The majority (n=13) were systematic reviews (four using meta-analysis.) Across the reviews, 26 different outcomes were reported with inconsistency. Follow-up duration varied within and across the reviews. Based on how authors had reported results, evidence clusters were developed: (1) staff-focused reviews, (2) discharge intervention reviews, (3) population-focused reviews and (4) intervention component reviews.ConclusionsThe evidence base describing interventions is weak due to inconsistent reporting, differing emphasis placed on the key characteristics of primary studies (staff, location and outcome) by review authors and varying quality of reviews. No individual interventions have been found to be more promising, but interventions initiated in the ED and continued into other settings have tended to result in more favourable patient and health service outcomes. Despite many interventions reported within the reviews being holistic and patient focused, outcomes measured were largely service focused.PROSPERO registration numberPROSPERO CRD42018111461.

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“…9 However, other studies have shown mixed results on the impacts of nurse-led interventions, demonstrating there is still more work to do to understand the best models of care. 10 As frontline providers, nurses offer a unique perspective on caring for older adults in the ED. Nurses are the most numerous health professionals in the ED and often the first and most frequent point of contact for patients.…”

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confidence: 99%

Improving care for older adults in the Emergency Department warrants greater investment in geriatric nursing—Stat!

Hunt

2020

Geriatric Nursing

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Article history: Available online xxx A B S T R A C TOlder adults use the Emergency Department (ED) more than any other age group besides infants. Despite high utilization, both the physical environment and care processes in the traditional ED are poorly suited to address the complex needs of older adults. As a result, older adults often experience poor outcomes in the ED. Geriatric nursing has been at the forefront of efforts to develop Geriatric Emergency Department Interventions (GEDI's) to try to address these deficits and improve care. As frontline providers with frequent patient contact, nursing brings critical viewpoints to these issues. This article provides some resources and other ideas for how frontline nurses can improve care for older adults in the ED. Ultimately, to have meaningful impacts on care of older adults in the ED, there is a dire need for greater financial investment specific to geriatric nursing education, training, and research in the ED.

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The impact of geriatric focused nurse assessment and intervention in the emergency department: A systematic review

Cited by 20 publications

References 32 publications

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Improving outcomes for older people in the emergency department: a review of reviews

Improving care for older adults in the Emergency Department warrants greater investment in geriatric nursing—Stat!

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