Using the 4M Model to Screen Geriatric Patients in the Emergency Department

Megalla, Martinus; Avula, Roopa; Manners, Christopher; Chinnery, Portia; Perrella, Lindsey; Finefrock, Douglas

doi:10.17294/2694-4715.1013

Cited by 6 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 3D/3D+ is in line with other recently implemented innovative proposals for improving the care of elderly patients in Eds, such as the proposal of Megalla et al [45] based on the 4M model-what matters, medication, mentation, and mobility-for providing care for older adults devised by the Institute for Healthcare Improvement (IHI) [46], or Puig-Campmany et al [47] Program of Care for Frailty development. The EDs where these studies were carried out obtained Emergency Department Accreditation from the American College of Emergency Physicians.…”

Section: Discussionsupporting

confidence: 56%

Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older

Garcia-Pérez,

Vena-Martínez,

Robles-Perea

et al. 2023

JCM

View full text Add to dashboard Cite

The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83–90) were analyzed. According to the baseline component (3D), 83.1% (95% CI: 78.2–87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95% CI: 54.1–65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95% CI: 93.0–98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95% CI: 0.73–0.86) for predicting 30-day mortality. The 3D/3D+ tool enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients’ discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.

show abstract

Section: Discussionsupporting

confidence: 56%

Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older

Garcia-Pérez,

Vena-Martínez,

Robles-Perea

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Despite the paucity of routine practices, some initiatives do exist. These successful initiatives include screening for completion of advanced directives 31 or a living will on entry to the ED, routinely asking the "top three things you feel would make this a successful, useful or valuable visit," 32 staff engagement of older adults during periods of ED waiting to inquire about personal priorities, 33 as well as successful prehospital initiatives by emergency medicine services simply asking "What matters to you today"? 34 The importance of identifying short-and long-term goals of older adult patients and their caregivers or family members remains a challenge in the ED environment.…”

Section: What Mattersmentioning

confidence: 99%

Enhancing healthcare access for an older population: The age‐friendly emergency department

Lee,

Skains,

Magidson

et al. 2024

JACEP Open

View full text Add to dashboard Cite

Healthcare systems face significant challenges in meeting the unique needs of older adults, particularly in the acute setting. Age‐friendly healthcare is a comprehensive approach using the 4Ms framework—what matters, medications, mentation, and mobility—to ensure that healthcare settings are responsive to the needs of older patients. The Age‐Friendly Emergency Department (AFED) is a crucial component of a holistic age‐friendly health system. Our objective is to provide an overview of the AFED model, its core principles, and the benefits to older adults and healthcare clinicians. The AFED optimizes the delivery of emergency care by integrating age‐specific considerations into various aspects of (1) ED physical infrastructure, (2) clinical care policies, and (3) care transitions. Physical infrastructure incorporates environmental modifications to enhance patient safety, including adequate lighting, nonslip flooring, and devices for sensory and ambulatory impairment. Clinical care policies address the physiological, cognitive, and psychosocial needs of older adults while preserving focus on emergency issues. Care transitions include communication and involving community partners and case management services. The AFED prioritizes collaboration between interdisciplinary team members (ED clinicians, geriatric specialists, nurses, physical/occupational therapists, and social workers). By adopting an age‐friendly approach, EDs have the potential to improve patient‐centered outcomes, reduce adverse events and hospitalizations, and enhance functional recovery. Moreover, healthcare clinicians benefit from the AFED model through increased satisfaction, multidisciplinary support, and enhanced training in geriatric care. Policymakers, healthcare administrators, and clinicians must collaborate to standardize guidelines, address barriers to AFEDs, and promote the adoption of age‐friendly practices in the ED.

show abstract

“…In addition to the 4 M model, the Institute for Healthcare Improvement has structured frameworks for implementing the 4Ms in inpatient and outpatient office settings 11 . While the VA is an ideal system for adopting these frameworks, implementing either in the ED can be challenging for the following reasons: (1) the current clinical condition of the patient; (2) time constraints of ED staff; (3) lack of a previous relationship with the patient; and (4) the nuances of the available frameworks, which do not lend themselves to an ED setting 13,14 . Success of geriatric ED programs using a screening model in which they identify high risk older adults, then provide additional screening and care coordination by geriatric emergency medicine trained champions provides an innovative framework for integrating the 4Ms into ED care that does not rely on either the inpatient or outpatient Institute for Healthcare Improvement framework 7,8,15 …”

Section: Introductionmentioning

confidence: 99%

“…11 While the VA is an ideal system for adopting these frameworks, implementing either in the ED can be challenging for the following reasons: (1) the current clinical condition of the patient; (2) time constraints of ED staff; (3) lack of a previous relationship with the patient; and (4) the nuances of the available frameworks, which do not lend themselves to an ED setting. 13,14 Success of geriatric ED programs using a screening model in which they identify high risk older adults, then provide additional screening and care coordination by geriatric emergency medicine trained champions provides an innovative framework for integrating the 4Ms into ED care that does not rely on either the inpatient or outpatient Institute for Healthcare Improvement framework. 7,8,15 In 2020, the VA Offices of Emergency Medicine and Geriatrics & Extended Care launched 20 VA facilities toward a goal of geriatric ED accreditation as phase one of a three-phase initiative to promote geriatric emergency medicine across the VA enterprise.…”

mentioning

confidence: 99%

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

McQuown

Snell

Abbate

et al. 2022

Health Services Research

View full text Add to dashboard Cite

Objective To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age‐Friendly Health Systems via the emergency department (ED) follow‐up home visits supported by telehealth. Data Sources and Study Setting Data sources were a pre‐implementation site survey and pilot phase individual‐level patient data from six US Department of Veterans Affairs (VA) EDs. Study Design A pre‐implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high‐risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow‐up telephone, or home visits. During the follow‐up visit, ICTs identified “what matters,” performed geriatric screens aligned with Age‐Friendly Health Systems, observed home safety risks, assisted with video telehealth check‐ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. Data Collection/Extraction Methods Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May–October 2021. Principle Findings Site surveys showed none of the EDs had a formalized way of identifying the 4 M “what matters.” During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow‐up. Conclusions A post‐ED follow‐up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

show abstract

Using the 4M Model to Screen Geriatric Patients in the Emergency Department

Cited by 6 publications

References 0 publications

Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older

Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older

Enhancing healthcare access for an older population: The age‐friendly emergency department

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

Contact Info

Product

Resources

About