Pub Date : 2022-01-01Epub Date: 2023-02-17DOI: 10.17294/2694-4715.1041
Ilianna Santangelo, Surriya Ahmad, Shan Liu, Lauren T Southerland, Christopher Carpenter, Ula Hwang, Adriane Lesser, Nicole Tidwell, Kevin Biese, Maura Kennedy
Introduction: Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.
Methods: This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We a priori selected five GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes.
Results: A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls were the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing the use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function, and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. Medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses. Protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function.
Conclusion: This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeny in how these care processes are implemented.
{"title":"Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments.","authors":"Ilianna Santangelo, Surriya Ahmad, Shan Liu, Lauren T Southerland, Christopher Carpenter, Ula Hwang, Adriane Lesser, Nicole Tidwell, Kevin Biese, Maura Kennedy","doi":"10.17294/2694-4715.1041","DOIUrl":"10.17294/2694-4715.1041","url":null,"abstract":"<p><strong>Introduction: </strong>Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.</p><p><strong>Methods: </strong>This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We <i>a priori</i> selected five GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes.</p><p><strong>Results: </strong>A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls were the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing the use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function, and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. Medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses. Protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function.</p><p><strong>Conclusion: </strong>This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeny in how these care processes are implemented.</p>","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035774/pdf/nihms-1883085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9197754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anita Chary, Shan W Liu, Lauren Southerland, Lauren Cameron-Comasco, Kei Ouchi, Christopher R Carpenter, Edward W Boyer, Aanand D Naik, Maura Kennedy
risk stratification
{"title":"Emergency Department Policies to Improve Care Experiences for Older Adults During the COVID-19 Pandemic.","authors":"Anita Chary, Shan W Liu, Lauren Southerland, Lauren Cameron-Comasco, Kei Ouchi, Christopher R Carpenter, Edward W Boyer, Aanand D Naik, Maura Kennedy","doi":"10.17294/2694-4715.1031","DOIUrl":"https://doi.org/10.17294/2694-4715.1031","url":null,"abstract":"risk stratification","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473422/pdf/nihms-1829689.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9555227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"It Takes Courage to Pause: Rapid Goals-of-Care Conversations in the Emergency Department","authors":"A. Chary, A. Naik, K. Ouchi","doi":"10.17294/2694-4715.1020","DOIUrl":"https://doi.org/10.17294/2694-4715.1020","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46999723","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}
Paige L. Morizio, V. Mistry, Ashley McKnight, Marc J Pepin, William E. Bryan, R. Owenby, Laura Previll, L. Ragsdale
Patients age 60 and older represented 20% of Emergency Department (ED) visits between 2014 and 2017.1 Within the Veterans Affairs Health Care System (VAHCS), 49% of patients presenting to the ED were age 65 and older in 2019.2 Older adults often have more prescription medications and increased medical complexity.3 One study suggests that at least 39% of patients over the age of 65 years are prescribed at least 5 medications, and that overall number of prescribed medications increases with age.4 Although 5 or more medications is the most cited definition, polypharmacy has been described ranging from 2 to 11 or more medications.5 Specific medication classes that increase the risk of harm or falls in older adults include antiarrhythmics, anticholinergics, anticoagulants, anticonvulsants, antidepressants, antihyperglycemics, antihypertensives, antipsychotics, anxiolytics, opioids, sedatives, and skeletal muscle relaxants.6,7 In addition, over 50% of older adults have been prescribed at least one medication that is potentially inappropriate.8
{"title":"Polypharmacy and High-risk Medications in Older Veterans Presenting for Emergency Care","authors":"Paige L. Morizio, V. Mistry, Ashley McKnight, Marc J Pepin, William E. Bryan, R. Owenby, Laura Previll, L. Ragsdale","doi":"10.17294/2694-4715.1007","DOIUrl":"https://doi.org/10.17294/2694-4715.1007","url":null,"abstract":"Patients age 60 and older represented 20% of Emergency Department (ED) visits between 2014 and 2017.1 Within the Veterans Affairs Health Care System (VAHCS), 49% of patients presenting to the ED were age 65 and older in 2019.2 Older adults often have more prescription medications and increased medical complexity.3 One study suggests that at least 39% of patients over the age of 65 years are prescribed at least 5 medications, and that overall number of prescribed medications increases with age.4 Although 5 or more medications is the most cited definition, polypharmacy has been described ranging from 2 to 11 or more medications.5 Specific medication classes that increase the risk of harm or falls in older adults include antiarrhythmics, anticholinergics, anticoagulants, anticonvulsants, antidepressants, antihyperglycemics, antihypertensives, antipsychotics, anxiolytics, opioids, sedatives, and skeletal muscle relaxants.6,7 In addition, over 50% of older adults have been prescribed at least one medication that is potentially inappropriate.8","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45253244","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":"Geriatric Emergency Medicine Fellowship Journal Club: Frailty","authors":"S. Keene, R. Fisher, L. Cameron-Comasco","doi":"10.17294/2694-4715.1011","DOIUrl":"https://doi.org/10.17294/2694-4715.1011","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41968958","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":"Intermediate Care Technicians-A Novel Workforce for Veterans Affairs Geriatric Emergency Departments","authors":"Kristina T. Snell, T. Edes, C. McQuown","doi":"10.17294/2694-4715.1014","DOIUrl":"https://doi.org/10.17294/2694-4715.1014","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48137657","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":"Ten Clinical Tips in the Assessment of Genitourinary Emergencies of an Older Adult","authors":"Nicole Soria, D. Khoujah","doi":"10.17294/2694-4715.1017","DOIUrl":"https://doi.org/10.17294/2694-4715.1017","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48550966","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":"Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, and Health-Care Provider Perspectives","authors":"K. Fuji, A. Malsch, Pamela Martin","doi":"10.17294/2694-4715.1018","DOIUrl":"https://doi.org/10.17294/2694-4715.1018","url":null,"abstract":"","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45143372","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}
J. V. van Oppen, E. Regen, K. Phelps, T. Coats, J. Valderas, S. Conroy, N. Mackintosh
The Covid-19 pandemic has prompted changes to healthcare processes unseen in recent history, causing substantial stress for both patients and healthcare professionals. Daily life has changed dramatically for older people with frailty. Those living in our local (Leicester City) community have experienced the UK’s longest movement restrictions, with the clinically vulnerable having minimal direct contact with others for more than eighteen months. We are researchers in geriatric emergency medicine with both clinical and non-clinical backgrounds. Our recent qualitative studies have focused on understanding healthcare experiences and outcome goals among older people with frailty and acute care needs, aiming for their robust measurement and ultimate improvement. We had been performing interview and ethnographic studies when Covid-19 restrictions were imposed. In this article, we report our experience of the barriers and benefits for qualitative research presented by pandemic restrictions.
{"title":"Barriers and Benefits Experienced in Qualitative Geriatric Emergency Care Research during the Covid-19 Era","authors":"J. V. van Oppen, E. Regen, K. Phelps, T. Coats, J. Valderas, S. Conroy, N. Mackintosh","doi":"10.17294/2694-4715.1012","DOIUrl":"https://doi.org/10.17294/2694-4715.1012","url":null,"abstract":"The Covid-19 pandemic has prompted changes to healthcare processes unseen in recent history, causing substantial stress for both patients and healthcare professionals. Daily life has changed dramatically for older people with frailty. Those living in our local (Leicester City) community have experienced the UK’s longest movement restrictions, with the clinically vulnerable having minimal direct contact with others for more than eighteen months. We are researchers in geriatric emergency medicine with both clinical and non-clinical backgrounds. Our recent qualitative studies have focused on understanding healthcare experiences and outcome goals among older people with frailty and acute care needs, aiming for their robust measurement and ultimate improvement. We had been performing interview and ethnographic studies when Covid-19 restrictions were imposed. In this article, we report our experience of the barriers and benefits for qualitative research presented by pandemic restrictions.","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48840960","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}
Rami Tarabay, Adam Perry, Riwa Al Aridi, M. Malone
he Emergency Department (ED) is a critical component of the geriatric continuum of care. Older adults comprise up to 25% of ED attendance and 38% of patients transported by emergency medical services (EMS.)2-4 Despite this, the traditional rapid linear ED treatment framework remains illequipped to meet the complex care needs of many vulnerable older adults.5-8 Upon discharge, the ED-to-home transition is a high-risk time for older adults. About one third of older adults will suffer an adverse result including ED revisit, eventual hospital referral, admission to a long-term care institution, or death within 3 months of the ED visit.9 Moreover, extended or frequent ED visits and repeated hospitalizations are costly. It has been reported that the cost of two potentially preventable geriatric syndromes, hospital delirium and repeated falls, is projected to be $83 billion a year in the United States.10,11
{"title":"Can an Emergency Department Adequately Address an Older Adult who has Complex Needs?","authors":"Rami Tarabay, Adam Perry, Riwa Al Aridi, M. Malone","doi":"10.17294/2694-4715.1015","DOIUrl":"https://doi.org/10.17294/2694-4715.1015","url":null,"abstract":"he Emergency Department (ED) is a critical component of the geriatric continuum of care. Older adults comprise up to 25% of ED attendance and 38% of patients transported by emergency medical services (EMS.)2-4 Despite this, the traditional rapid linear ED treatment framework remains illequipped to meet the complex care needs of many vulnerable older adults.5-8 Upon discharge, the ED-to-home transition is a high-risk time for older adults. About one third of older adults will suffer an adverse result including ED revisit, eventual hospital referral, admission to a long-term care institution, or death within 3 months of the ED visit.9 Moreover, extended or frequent ED visits and repeated hospitalizations are costly. It has been reported that the cost of two potentially preventable geriatric syndromes, hospital delirium and repeated falls, is projected to be $83 billion a year in the United States.10,11","PeriodicalId":73757,"journal":{"name":"Journal of geriatric emergency medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47463265","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号