K. Erwander, Kjell Ivarsson, M. Landin-Olsson, B. Agvall
Introduction The Emergency Department (ED) is a common route to hospitalization for critically ill and older adults. Older patients are admitted to hospital at a higher rate and have longer length of stay (LOS) when hospitalized. To be able to confront an increasing aging population, meet their medical needs and influence rising costs of health care, there is a need to focus on the older population. In Scandinavia, few studies are made that focus on the geriatric population at the ED. It is essential to early identify risk factors for hospitalization at the ED to improve the medical care for older adults and the influence of prehospital comorbidities. Methods This is a retrospective observational study of older adults visiting the ED in southwest Sweden. The aim of this study was to examine if routinely collected patient demographics and prehospital comorbidities were associated with ED disposition and in-patient process outcomes. The data collection was generated from the Regional Healthcare Information Platform. The variables extracted were age, gender, ED-visits, LOS at ED, admission rate, in-hospital LOS and comorbidities before visiting the ED. Results A total of 15 528 patients aged > 65 years visited the ED during 2016, 8 098 (52%) were female and 7 430 (48%) were male, 6 631 (41%) were 65-74 years of age, 5 585 (36%) were 75-84 years of age and 3 612 (23%) were 85 years or older. LOS at the ED were over 4 hours for 45% of the population. Patients aged 85 or older had a Hazard ratio of 2.56 (CI 2.33-2.82) for admission and patients with HF had a Hazard ratio of 1.75 (CI 1.46-2.09).
{"title":"Pre-hospital conditions affecting the hospitalization risk in older adults at the Emergency Department","authors":"K. Erwander, Kjell Ivarsson, M. Landin-Olsson, B. Agvall","doi":"10.17294/2694-4715.1039","DOIUrl":"https://doi.org/10.17294/2694-4715.1039","url":null,"abstract":"Introduction The Emergency Department (ED) is a common route to hospitalization for critically ill and older adults. Older patients are admitted to hospital at a higher rate and have longer length of stay (LOS) when hospitalized. To be able to confront an increasing aging population, meet their medical needs and influence rising costs of health care, there is a need to focus on the older population. In Scandinavia, few studies are made that focus on the geriatric population at the ED. It is essential to early identify risk factors for hospitalization at the ED to improve the medical care for older adults and the influence of prehospital comorbidities. Methods This is a retrospective observational study of older adults visiting the ED in southwest Sweden. The aim of this study was to examine if routinely collected patient demographics and prehospital comorbidities were associated with ED disposition and in-patient process outcomes. The data collection was generated from the Regional Healthcare Information Platform. The variables extracted were age, gender, ED-visits, LOS at ED, admission rate, in-hospital LOS and comorbidities before visiting the ED. Results A total of 15 528 patients aged > 65 years visited the ED during 2016, 8 098 (52%) were female and 7 430 (48%) were male, 6 631 (41%) were 65-74 years of age, 5 585 (36%) were 75-84 years of age and 3 612 (23%) were 85 years or older. LOS at the ED were over 4 hours for 45% of the population. Patients aged 85 or older had a Hazard ratio of 2.56 (CI 2.33-2.82) for admission and patients with HF had a Hazard ratio of 1.75 (CI 1.46-2.09).","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43745962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Geriatric Emergency Department at the University of California San Francisco: Structures, Roles, and Lessons Learned","authors":"T. James","doi":"10.17294/2694-4715.1040","DOIUrl":"https://doi.org/10.17294/2694-4715.1040","url":null,"abstract":"The","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45416383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachael Sheehan, Ashley Stajkowski, Lee Hraby, Melanie Mommaerts, Tyler Nichols, Marisa Nichols, A.J. Beuning, Victor Warne
Introduction Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety. The goal of this project was to evaluate the impact of a comprehensive home medication list review performed by a pharmacist for patients 65 years or older within the ED, in conjunction with ED provider education on potential interventions. Methods This retrospective study compared the average number of home medication modifications made per patient by ED providers at baseline compared to intervention implementation of provider education and pharmacist home medication list review. Additionally, the rate of return to the ED was also compared. Data were collected through manual chart review. Secondary outcomes include total number of pharmacist recommendations, average number of pharmacist recommendations per patient, total number of Medication Management Services (MMS) referrals, total number of MMS consults completed, and total number of MMS interventions. Results There was a statically significant increase in the average number of medications changes per patient on discharge between the two groups with an average of 0.1 changes (SD 0.3, 0.0-2.0) in the pre-intervention group and 0.7 changes (SD 1.5, 0.0-7.0; p<0.001) in the post-intervention group. There also was a statistically significant increase in the percentage of patients with a home medication
{"title":"Effect of Pharmacist Intervention on Emergency Department Geriatric Patients with Polypharmacy","authors":"Rachael Sheehan, Ashley Stajkowski, Lee Hraby, Melanie Mommaerts, Tyler Nichols, Marisa Nichols, A.J. Beuning, Victor Warne","doi":"10.17294/2694-4715.1034","DOIUrl":"https://doi.org/10.17294/2694-4715.1034","url":null,"abstract":"Introduction Polypharmacy is common within the geriatric population due to the commonality of multiple comorbidities and use of multiple providers. The emergency department (ED) is a prime location to capture these patients, especially when they present with chief complaints which may be medication related. Much of this population is prescribed potentially inappropriate medications which increases their risk for adverse drug reactions. Pharmacist review of patient home medication lists has been shown to decrease the number of potentially inappropriate medications, as well as medication-related problems, such as therapeutic duplications and drug interactions. These reductions can increase patient safety. The goal of this project was to evaluate the impact of a comprehensive home medication list review performed by a pharmacist for patients 65 years or older within the ED, in conjunction with ED provider education on potential interventions. Methods This retrospective study compared the average number of home medication modifications made per patient by ED providers at baseline compared to intervention implementation of provider education and pharmacist home medication list review. Additionally, the rate of return to the ED was also compared. Data were collected through manual chart review. Secondary outcomes include total number of pharmacist recommendations, average number of pharmacist recommendations per patient, total number of Medication Management Services (MMS) referrals, total number of MMS consults completed, and total number of MMS interventions. Results There was a statically significant increase in the average number of medications changes per patient on discharge between the two groups with an average of 0.1 changes (SD 0.3, 0.0-2.0) in the pre-intervention group and 0.7 changes (SD 1.5, 0.0-7.0; p<0.001) in the post-intervention group. There also was a statistically significant increase in the percentage of patients with a home medication","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44408099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Cetin-Sahin, F. Ducharme, J. McCusker, Mona Magalhaes, N. Veillette, Paul-André Lachance, S. Cossette, A. Vadeboncoeur, Rick Mah, T. Vu, S. Berthelot
T.T
T.T
{"title":"Key Healthcare Providers’ Perspectives on the Implementation of Senior-Friendly Emergency Department Care in Quebec","authors":"D. Cetin-Sahin, F. Ducharme, J. McCusker, Mona Magalhaes, N. Veillette, Paul-André Lachance, S. Cossette, A. Vadeboncoeur, Rick Mah, T. Vu, S. Berthelot","doi":"10.17294/2694-4715.1033","DOIUrl":"https://doi.org/10.17294/2694-4715.1033","url":null,"abstract":"T.T","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42726181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine Briggie, Kaitlin Sweeney, S. Findlay, Hao Wang, Juan Pagan-Ferrer, Daniel G. Miller, Sangil Lee
Introduction The Physician Orders for Life-Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker. The aim of this study was to determine the level of awareness and understanding of the POLST form amongst providers at two ACGME-accredited emergency medicine residency programs. Methods In this needs assessment study, we assessed awareness by sending a 13-item survey to all residents, faculty, and advanced practice providers in the two EDs in the United States. The content of the survey was developed by the study team using a modified Delphi process with content validity evaluated by a panel of emergency medicine and palliative care experts. We evaluated the association between the level of comfort and knowledge using the form and the level of training using the bivariate analysis. Results Of the 205 questionnaires distributed, we received 63 responses (31%). Only 44% of responders reported using a POLST in the past year, and 40% did not feel comfortable interpreting and applying a POLST. Seventy percent of responders do not know where to locate this form. Furthermore, trainees reported a higher degree of familiarity and comfort with POLST forms when compared to staff physicians. Conclusion A significant minority of ED providers do not know how to properly apply a POLST form. Our data suggests opportunities to educate ED personnel on locating and applying the POLST form.
{"title":"Emergency medicine provider comfort with Physician Orders for Life Sustaining Treatment (POLST) advanced directive","authors":"Katherine Briggie, Kaitlin Sweeney, S. Findlay, Hao Wang, Juan Pagan-Ferrer, Daniel G. Miller, Sangil Lee","doi":"10.17294/2694-4715.1038","DOIUrl":"https://doi.org/10.17294/2694-4715.1038","url":null,"abstract":"Introduction The Physician Orders for Life-Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker. The aim of this study was to determine the level of awareness and understanding of the POLST form amongst providers at two ACGME-accredited emergency medicine residency programs. Methods In this needs assessment study, we assessed awareness by sending a 13-item survey to all residents, faculty, and advanced practice providers in the two EDs in the United States. The content of the survey was developed by the study team using a modified Delphi process with content validity evaluated by a panel of emergency medicine and palliative care experts. We evaluated the association between the level of comfort and knowledge using the form and the level of training using the bivariate analysis. Results Of the 205 questionnaires distributed, we received 63 responses (31%). Only 44% of responders reported using a POLST in the past year, and 40% did not feel comfortable interpreting and applying a POLST. Seventy percent of responders do not know where to locate this form. Furthermore, trainees reported a higher degree of familiarity and comfort with POLST forms when compared to staff physicians. Conclusion A significant minority of ED providers do not know how to properly apply a POLST form. Our data suggests opportunities to educate ED personnel on locating and applying the POLST form.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46203242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clara V. Kuranz, R. Green, Angela Gifford, G. Jacobsohn, T. Caprio, Amy L. Cochran, Jeremy T. Cushman, Courtney M. C. Jones, A. Kind, M. Lohmeier, M. Shah
M.C
司仪
{"title":"The Effect of the Care Transitions Intervention on ED Revisits and Outpatient Clinic Follow-Up among Older Adults Who Live Alone","authors":"Clara V. Kuranz, R. Green, Angela Gifford, G. Jacobsohn, T. Caprio, Amy L. Cochran, Jeremy T. Cushman, Courtney M. C. Jones, A. Kind, M. Lohmeier, M. Shah","doi":"10.17294/2694-4715.1037","DOIUrl":"https://doi.org/10.17294/2694-4715.1037","url":null,"abstract":"M.C","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46458795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Research to Accelerate Practice Change in Geriatric Emergency Medicine","authors":"Susan C. Hastings","doi":"10.17294/2694-4715.1036","DOIUrl":"https://doi.org/10.17294/2694-4715.1036","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42011607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addressing complex primary care needs for an older man recently released from incarceration with multiple emergency department visits.","authors":"Saffia T. Bajwa, Ariba Khan, M. Malone","doi":"10.17294/2694-4715.1030","DOIUrl":"https://doi.org/10.17294/2694-4715.1030","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca Weeks, K. Sawasky, Adam Perry, Michael Malone
{"title":"Navigating Care Transitions for Older Adults in the Emergency Department When a Social Worker is Unavailable","authors":"Rebecca Weeks, K. Sawasky, Adam Perry, Michael Malone","doi":"10.17294/2694-4715.1023","DOIUrl":"https://doi.org/10.17294/2694-4715.1023","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47973382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delirium is an acute fluctuating condition characterized by an alteration in the level of consciousness associated with inattention and disorganized thinking. Delirium is known to cause increased morbidity and mortality in older adults. It has been associated with prolonged hospitalizations,1 functional decline,2 and cognitive decline.3 Delirium can either be present on arrival to the ED, early during the ED course (prevalent delirium), or develop during hospitalization in a patient who was initially not delirious in the ED (incident delirium). Delirium is missed in >50% of cases when screening is not performed.4-5 In addition, approximately 25% of older adults with delirium are discharged from the ED.6 Therefore, delirium screening, as well as mitigation of ED risk factors, are imperative to patient care. For this installment of the Geriatric Emergency Medicine Fellowship Journal Club, we reviewed two articles related to delirium risk to understand which patients are at risk of developing delirium after arriving in the ED and what strategies could be considered in the ED to prevent the development of incident delirium.
{"title":"Geriatric Emergency Medicine Fellowship Journal Club: Operational Changes for Recognizing Prevalent Delirium and Preventing Incident Delirium","authors":"N. M. Elder","doi":"10.17294/2694-4715.1032","DOIUrl":"https://doi.org/10.17294/2694-4715.1032","url":null,"abstract":"Delirium is an acute fluctuating condition characterized by an alteration in the level of consciousness associated with inattention and disorganized thinking. Delirium is known to cause increased morbidity and mortality in older adults. It has been associated with prolonged hospitalizations,1 functional decline,2 and cognitive decline.3 Delirium can either be present on arrival to the ED, early during the ED course (prevalent delirium), or develop during hospitalization in a patient who was initially not delirious in the ED (incident delirium). Delirium is missed in >50% of cases when screening is not performed.4-5 In addition, approximately 25% of older adults with delirium are discharged from the ED.6 Therefore, delirium screening, as well as mitigation of ED risk factors, are imperative to patient care. For this installment of the Geriatric Emergency Medicine Fellowship Journal Club, we reviewed two articles related to delirium risk to understand which patients are at risk of developing delirium after arriving in the ED and what strategies could be considered in the ED to prevent the development of incident delirium.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42338409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：