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Jivalagian P, Gettel CJ, Smith CM, Robinson L, Brinker M, Shah D, Kumar A, Faustino IV, Nath B, Chang-Sing E, Taylor RA, Kennedy M, Hwang U, Wong AH. Racial, Ethnic, and Age-Related Disparities in Sedation and Restraint Use for Older Adults in the Emergency Department. Am J Geriatr Psychiatry 2024:S1064-7481(24)00398-1. [PMID: 39054237 DOI: 10.1016/j.jagp.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015-2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint. RESULTS Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29-1.42); 1.82 (1.73-1.91); 2.35 (2.15-2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27-1.34); 1.55 (1.50-1.60); 1.69 (1.59-1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18-1.35); AOR 1.22 (1.15-1.29)] and physical restraint [AOR 1.12 (95% CI 1.07-1.16); 1.22 (1.18-1.26)]. CONCLUSION Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults.
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Affiliation(s)
- Patelle Jivalagian
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Cameron J Gettel
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Colin M Smith
- Hubert-Yeargan Center for Global Health (CMS), Duke University, Durham, NC
| | - Leah Robinson
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Morgan Brinker
- Department of Emergency Medicine, Yale School of Medicine (MB), New Haven, CT
| | - Dhruvil Shah
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Anusha Kumar
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Isaac V Faustino
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Bidisha Nath
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - Erika Chang-Sing
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT
| | - R Andrew Taylor
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT; Department of Biomedical Informatics and Data Science (RAT), Yale School of Medicine, New Haven, CT
| | - Maura Kennedy
- Department of Emergency Medicine (MK), Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine (MK), Harvard Medical School, Boston, MA
| | - Ula Hwang
- Department of Emergency Medicine (UH), New York University Grossman School of Medicine, New York, NY; Geriatric Research Education and Clinical Center (UH), James J. Peters VAMC, Bronx, NY
| | - Ambrose H Wong
- Department of Emergency Medicine (PJ, CJG, LR, DS, AK, IVF, BN, ECS, RAT, AHW), Yale School of Medicine, New Haven, CT.
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Pinardi E, Ornago AM, Bianchetti A, Morandi A, Mantovani S, Marengoni A, Colombo M, Arosio B, Okoye C, Cortellaro F, Bellelli G. Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy. BMC Emerg Med 2024; 24:86. [PMID: 38764046 PMCID: PMC11103964 DOI: 10.1186/s12873-024-01004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older. METHODS An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023. The questionnaire covered hospital profiles, geriatric consultation practices, risk assessment tools, discharge processes and perspectives on geriatric emergency care. RESULTS In this mixed method research, 219 structured interviews were collected. The majority of physicians were employed in hospitals, with 54.7% being geriatricians. Critical gaps in older patient's care were identified, including the absence of dedicated care pathways, insufficient awareness of screening tools, and a need for enhanced professional training. CONCLUSIONS Tailored protocols and geriatric educational programs are crucial for improving the quality of emergency care provided to older individuals. These measures might also help relieve the burden on the Emergency Departments, thereby potentially enhancing overall efficiency and ensuring better outcomes.
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Affiliation(s)
- Elena Pinardi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy.
| | - Alice Margherita Ornago
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
| | - Angelo Bianchetti
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Medicine and Rehabilitation Department, Istituto Clinico S.Anna Hospital, Gruppo San Donato, Brescia, Italy
| | - Alessandro Morandi
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Intermediate Care and Rehabilitation, Azienda Speciale "Cremona Solidale", Cremona, Italy
- Parc Sanitari Pere Virgili, Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Stefano Mantovani
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- RSA Don Giuseppe Cuni, Magenta, Italy
| | - Alessandra Marengoni
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical and Experimental Sciences, Geriatric Unit, University of Brescia, Brescia, Italy
| | - Mauro Colombo
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Beatrice Arosio
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Francesca Cortellaro
- Integrazione Percorsi di Cura Ospedale Territorio, Urgency Emergency Regional Agency (Agenzia Regionale Emergenza Urgenza - AREU), Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Goodwin L, Liddiard C, Manning S, Benger JR, Carlton E, Cheston R, Hoskins R, Taylor H, Voss S. How do emergency department staff respond to behaviour that challenges displayed by people living with dementia? A mixed-methods study. BMJ Open 2023; 13:e075022. [PMID: 37541746 PMCID: PMC10407375 DOI: 10.1136/bmjopen-2023-075022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES To investigate staff experiences of, and approaches to behaviour that challenges displayed by patients with dementia in the emergency department (ED). Behaviour that challenges is defined as 'actions that detract from the well-being of individuals due to the physical or psychological distress they cause within the settings they are performed', and can take many forms including aggressive physical actions, shouting and verbal aggression and non-aggressive behaviour including repetitive questioning, inappropriate exposure and resistance to care. DESIGN Mixed-methods study consisting of an online survey and semistructured telephone interviews. Quantitative data were analysed and presented using descriptive statistics. Qualitative data were analysed thematically. SETTING The EDs of three National Health Service (NHS) Hospital Trusts in Southwest England. PARTICIPANTS Multidisciplinary NHS staff working in the ED. RESULTS Fifty-two online survey responses and 13 telephone interviews were analysed. Most (24/36, 67%) survey respondents reported that they had received general training in relation to dementia in the last 2-5 years, however, less than a fifth (4/23, 17%) had received any ED-specific dementia training. All (48/48) felt that behaviour that challenges could potentially be prevented, though resource constraints and practice variation were identified. Four main themes emerged from the qualitative data: (1) the 'perfect storm' of the ED; (2) behaviour that challenges is preventable with the right resources; (3) improvisation and (4) requirement for approaches that are specific to the ED. CONCLUSIONS The findings of this study suggest that ED staff do not feel that they are prepared to respond effectively to behaviour that challenges displayed by people living with dementia. Future work could adapt or develop an intervention to support ED staff in responding to behaviour that challenges.
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Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Cathy Liddiard
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Sera Manning
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | | | - Edward Carlton
- Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Cheston
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rebecca Hoskins
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Somes J. Increased Use of Cannabis in Our Older Adults-An Emerging Trend. J Emerg Nurs 2023; 49:499-506. [PMID: 37393075 DOI: 10.1016/j.jen.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 07/03/2023]
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Wang HJ, Kusumo RW, Kiss A, Tennen G, Marotta G, Viaje S, Lanctôt KL. Characterizing PRN Use of Psychotropic Medications for Acute Agitation in Canadian Long-Term Care Residents with Dementia Before and During COVID-19. J Alzheimers Dis Rep 2023; 7:575-587. [PMID: 37313488 PMCID: PMC10259051 DOI: 10.3233/adr-230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023] Open
Abstract
Background Agitation is a disabling neuropsychiatric symptom of dementia. Pro re nata (PRN) injections of psychotropics can be administered for severe acute agitation, but little is known about the frequency of their actual use. Objective Characterize actual use of injectable PRN psychotropics for severe acute agitation in Canadian long-term care (LTC) residents with dementia and compare use before and during the COVID-19 pandemic. Methods Residents from two Canadian LTC facilities with orders for PRN haloperidol, olanzapine, or lorazepam between January 1, 2018- May 1, 2019 (i.e., pre-COVID-19) and January 1, 2020- May 1, 2021 (i.e., COVID-19) were identified. Electronic medical records were reviewed to document PRN injections of psychotropic medications and collect data on reason and demographic characteristics. Descriptive statistics were used to characterize frequency, dose, and indications of use, and multivariate regression models were used to compare use between time periods. Results Of the 250 residents, 45 of 103 (44%) people in the pre-COVID-19 period and 85 of 147 (58%) people in the COVID-19 period with standing orders for PRN psychotropics received ≥1 injections. Haloperidol was the most frequently used agent in both time periods (74% (155/209 injections) pre-COVID-19; 81% (323/398 injections) during COVID-19). Residents in the COVID-19 period were almost two times more likely to receive injections compared with those in the pre-COVID-19 period (odds ratio = 1.96; 95% CI = 1.15-3.34; p = 0.01). Conclusion Our results suggest that use of PRN injections increased in LTC during the pandemic and contribute to the mounting evidence that agitation worsened during that time.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Raphael W. Kusumo
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gayla Tennen
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Giovanni Marotta
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Geriatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Shirley Viaje
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Krista L. Lanctôt
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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Somes J. Agitated Geriatric Patients and Violence in the Workplace. J Emerg Nurs 2023; 49:320-325. [PMID: 37150556 DOI: 10.1016/j.jen.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 05/09/2023]
Abstract
Older adults may suddenly exhibit behaviors that are viewed as noncompliant, noncooperative, and threatening. They may even lash out verbally and physically causing injury to health care staff. In addition to taking actions that prevent harm to the staff and the patient, determining what caused this behavior (dementia vs delirium or other cases) will be critical, as well as debriefing the staff after the incident.
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Emergency Psychiatry: Updates, Future Directions, and Core Concepts. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:70-71. [PMID: 37205034 PMCID: PMC10172547 DOI: 10.1176/appi.focus.23022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Curry A, Malas N, Mroczkowski M, Hong V, Nordstrom K, Terrell C. Updates in the Assessment and Management of Agitation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:35-45. [PMID: 37205032 PMCID: PMC10172538 DOI: 10.1176/appi.focus.20220064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Agitated patients can be dangerous to themselves and others. In fact, severe medical complications and death can occur with severe agitation. Because of this, agitation is considered a medical and psychiatric emergency. Regardless of the treatment setting, identifying the agitated patient early is a necessary skill. The authors review relevant literature regarding the identification and management of agitation and summarize current recommendations for adults, as well as children and adolescents.
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Affiliation(s)
- Ashley Curry
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
| | - Nasuh Malas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
| | - Megan Mroczkowski
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
| | - Victor Hong
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
| | - Kimberly Nordstrom
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
| | - Christina Terrell
- Department of Psychiatry, University of Colorado School of Medicine, Aurora (Curry, Nordstrom); Department of Psychiatry (Malas, Hong) and Department of Pediatrics (Malas), University of Michigan, Ann Arbor; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Mroczkowski); Department of Psychiatry, University of Louisville, Louisville, Kentucky (Terrell)
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Goldberg EM, Lin TR, Cunha CB, Mujahid N, Davoodi NM, Vaughan CP. Enhancing the quality of prescribing practices for older adults discharged from the emergency department in Rhode Island. J Am Geriatr Soc 2022; 70:2905-2914. [PMID: 35809226 PMCID: PMC9588533 DOI: 10.1111/jgs.17955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to examine the effectiveness of the Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUiPPED) medication safety program in three emergency departments (EDs) within the largest health system in Rhode Island (RI) with funding through a quality incentive payment by a private insurance partner. METHODS This study utilized a quasi-experimental interrupted time series design to implement EQUiPPED, a three-prong intervention aimed at reducing potentially inappropriate medication (PIM) prescriptions to 5% or less per month. We included clinicians who prescribed medications to older ED patients during the pre-and post-intervention periods from July 2018 to January 2021. We determined the monthly rate of PIM prescribing among older adults discharged from the ED, according to the American Geriatrics Society Beers Criteria, using Poisson regression. RESULTS 247 ED clinicians (48% attendings [n = 119], 27% residents [n = 67], 25% advanced practice providers [n = 61]) were included in EQUiPPED, of which 92% prescribed a PIM during the study period. In the pre-implementation period (July 2018-July 2019) the average monthly rate of PIM prescribing was 9.30% (95% CI: 8.82%, 9.78%). In the post-implementation period (October 2019-January 2021) the PIM prescribing rate decreased significantly to 8.62% (95% CI: 8.14%, 9.10%, p < 0.01). During pre-implementation, 1325 of the 14,193 prescribed medications were considered inappropriate, while only 1108 of the 13,213 prescribed medications in post-implementation were considered inappropriate. The greatest reduction was observed among antihistamines, skeletal muscle relaxants, and benzodiazepines. CONCLUSIONS EQUiPPED contributed to a modest improvement in PIM prescribing to older adults among clinicians in these RI EDs even in the midst of the COVID-19 pandemic. The quality incentive funding model demonstrates a successful strategy for implementation and, with greater replication, could shape national policy regarding health care delivery and quality of care for older adults.
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Affiliation(s)
| | - Timmy R Lin
- Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Cheston B Cunha
- Infectious Disease, Brown University, Providence, Rhode Island, USA
| | - Nadia Mujahid
- Division of Geriatric & Palliative Medicine, Brown University, Providence, Rhode Island, USA
| | | | - Camille P Vaughan
- Division of Geriatrics and Gerontology, Emory University, Birmingham/Atlanta VA GRECC, Atlanta, Georgia, USA
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Dresden SM, Taylor Z, Serina P, Kennedy M, Wescott AB, Hogan T, Shah MN, Hwang U. Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review. J Am Med Dir Assoc 2022; 23:1314.e1-1314.e29. [PMID: 35940683 DOI: 10.1016/j.jamda.2022.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWDs in the ED. METHODS The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities. RESULTS From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs. CONCLUSIONS AND IMPLICATIONS A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Zachary Taylor
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Peter Serina
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Annie B Wescott
- Galter Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Teresita Hogan
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
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Lee S, Chen H, Hibino S, Miller D, Healy H, Lee JS, Arendts G, Han JH, Kennedy M, Carpenter CR. Can we improve delirium prevention and treatment in the emergency department? A systematic review. J Am Geriatr Soc 2022; 70:1838-1849. [PMID: 35274738 PMCID: PMC9314609 DOI: 10.1111/jgs.17740] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This systematic review was conducted to evaluate any interventions to prevent incident delirium, or shorten the duration of prevalent delirium, in older adults presenting to the emergency department (ED). METHODS Health sciences librarian designed electronic searches were conducted from database inception through September 2021. Two authors reviewed studies, and included studies that evaluated interventions for the prevention and/or treatment of delirium and excluded non-ED studies. The risk of bias (ROB) was evaluated by the Cochrane ROB tool or the Newcastle-Ottawa (NOS) scale. Meta-analysis was conducted to estimate a pooled effect of multifactorial programs on delirium prevention. RESULTS Our search strategy yielded 11,900 studies of which 10 met study inclusion criteria. Two RCTs evaluated pharmacologic interventions for delirium prevention; three non-RCTs employed a multi-factorial delirium prevention program; three non-RCTs evaluated regional anesthesia for hip fractures; and one study evaluated the use of Foley catheter, medication exposure, and risk of delirium. Only four studies demonstrated a significant impact on delirium incidence or duration of delirium-one RCT of melatonin reduced the incidence of delirium (OR 0.19, 95% CI 0.06 to 0.62), one non-RCT study on a multi-factorial program decreased inpatient delirium prevalence (41% to 19%) and the other reduced incident delirium (RR 0.37, 95% CI 0.22 to 0.61). One case-control study on the use of ED Foley catheters in the ED increased the duration of delirium (proportional OR 3.1, 95% CI 1.3 to 7.4). A pooled odds ratio for three multifactorial programs on delirium prevention was 0.46 (95% CI 0.31-0.68, I2 = 0). CONCLUSION Few interventions initiated in the ED were found to consistently reduce the incidence or duration of delirium. Delirium prevention and treatment trials in the ED are still rare and should be prioritized for future research.
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Affiliation(s)
- Sangil Lee
- Department of Emergency MedicineUniversity of Iowa Roy J and Lucille A Carver College of MedicineIowa CityIowaUSA
| | - Hao Chen
- Department of Emergency MedicineUniversity of Iowa Roy J and Lucille A Carver College of MedicineIowa CityIowaUSA
| | - Seikei Hibino
- Department of Emergency MedicineUniversity of Minnesota Medical CenterMinneapolisMinnesotaUSA
| | - Daniel Miller
- Department of Emergency MedicineUniversity of Iowa Roy J and Lucille A Carver College of MedicineIowa CityIowaUSA
| | - Heather Healy
- Hardin Library for the Health SciencesUniversity of IowaIowa CityIowaUSA
| | - Jacques S. Lee
- Schwartz/Reisman Emergency Medicine InstituteSinai HealthTorontoONCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Glenn Arendts
- Emergency MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Jin Ho Han
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Geriatric Research, Education, and Clinical CenterTennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
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12
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Malone K, Saveen S, Hollier J. In an Emergency Setting, What Is the Best Intramuscular Pharmacological Treatment to Give to an Agitated Geriatric Patient? Cureus 2022; 14:e25382. [PMID: 35774721 PMCID: PMC9239320 DOI: 10.7759/cureus.25382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Herein, we describe an agitated geriatric patient who suffered an adverse outcome due to treatment for agitation in an emergency setting. This led to the prompt review of the current literature on best-practice medication to use in this population. After careful review, the authors recommend olanzapine as the first-line medication for agitation due to its lower risk-averse effect profile when compared to other medications used for this patient population.
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13
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Chary AN, Castilla-Ojo N, Joshi C, Santangelo I, Carpenter CR, Ouchi K, Naik AD, Liu SW, Kennedy M. Evaluating older adults with cognitive dysfunction: A qualitative study with emergency clinicians. J Am Geriatr Soc 2022; 70:341-351. [PMID: 34796476 PMCID: PMC9200057 DOI: 10.1111/jgs.17581] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evaluating older adults with cognitive dysfunction in emergency departments (EDs) requires obtaining collateral information from sources other than the patient. Understanding the challenges emergency clinicians face in obtaining collateral information can inform development of interventions to improve geriatric emergency care and, more specifically, detection of ED delirium. The objective was to understand emergency clinicians' experiences obtaining collateral information on older adults with cognitive dysfunction, both before and during the COVID-19 pandemic. METHODS From February to May 2021, we conducted semi-structured interviews with a purposive sample of 22 emergency physicians and advanced practice providers from two urban academic hospitals and one community hospital in the Northeast United States. Interviews lasted 10-20 min and were digitally recorded and transcribed. Interview transcripts were analyzed for dominant themes using a combined deductive-inductive approach. Responses regarding experiences before and during the pandemic were compared. RESULTS Five major challenges emerged regarding (1) availability of caregivers, (2) reliability of sources, (3) language barriers, (4) time constraints, and (5) incomplete transfer documentation. Participants perceived all challenges, but those relating to transfer documentation were amplified by the COVID-19 pandemic. CONCLUSION Emergency clinicians' perspectives can inform efforts to support caregiver presence at bedside and develop standardized communication tools to improve recognition of delirium and, more broadly, geriatric emergency care.
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Affiliation(s)
- Anita N. Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Christopher Joshi
- School of Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher R. Carpenter
- Department of Emergency Medicine, Barnes Jewish Hospital, St. Louis, Missouri, USA
- Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Aanand D. Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Shan W. Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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14
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Lo AX, Wedel LK, Liu SW, Wongtangman T, Thatphet P, Santangelo I, Chary AN, Biddinger PD, Grudzen CR, Kennedy M. COVID-19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end-of-life care. J Am Coll Emerg Physicians Open 2022; 3:e12622. [PMID: 35079730 PMCID: PMC8776041 DOI: 10.1002/emp2.12622] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To characterize the national distribution of COVID-19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end-of-life care. METHODS Cross-sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID-19 pandemic, by trained study investigators using standardized instrument. RESULTS Of the 352 hospitals studied, 326 (93%) had a COVID-19 hospital-wide visitor restriction policy and 164 (47%) also had an ED-specific policy. Hospital-wide policies were more prevalent at academic than non-academic (96% vs 90%; P < 0.05) and at urban than rural sites (95% vs 84%; P < 0.001); however, the prevalence of ED-specific policies did not significantly differ across these site characteristics. Geographic region was not associated with the prevalence of any visitor policies. Among all study sites, only 58% of hospitals reported exceptions for patients receiving end-of-life care, 39% for persons with cognitive impairment, and 33% for persons with physical impairment, and only 12% provided policies in non-English languages. Sites with ED-specific policies reported even fewer exceptions for patients with cognitive impairment (29%), with physical impairments (24%), or receiving end-of-life care (26%). CONCLUSION Although the benefits of visitor policies towards curbing COVID-19 transmission had not been firmly established, such policies were widespread among US hospitals. Exceptions that permitted family or other caregivers for patients with cognitive or physical impairments or receiving end-of-life care were predominantly lacking, as were policies in non-English languages.
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Affiliation(s)
- Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Center for Health Services & Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Logan K. Wedel
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Thiti Wongtangman
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineLerdsin General HospitalBangkokThailand
| | - Phraewa Thatphet
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineFaculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Ilianna Santangelo
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Anita N. Chary
- Departments of Medicine and Emergency MedicineBaylor College of Medicine
| | - Paul D. Biddinger
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mass General BrighamBostonMassachusettsUSA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Maura Kennedy
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
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15
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Kennedy M, Koehl J, Gao J, Ciampa KA, Hayes BD, Camargo CA. Use of antipsychotic and sedative medications in older patients in the emergency department. J Am Geriatr Soc 2021; 70:731-742. [PMID: 34820831 DOI: 10.1111/jgs.17590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Antipsychotics and sedatives are used to treat agitation in the emergency department (ED) but carry significant risk in older adults. Our objective was to determine factors associated with their administration to older ED patients. METHODS This was an observational study using data from the 2014-2017 National Hospital Ambulatory Medical Care Survey. We identified ED visits for patients aged ≥65 years and determined whether an antipsychotic or sedative was administered. Visits related to substance use/withdrawal, other psychiatric complaints, and intubation were excluded. We performed multivariable logistic regression to identify risk factors for antipsychotic or sedative administration. RESULTS Of the 78.7 million ED visits that met inclusion criteria, 3.5% involved at least one dose of antipsychotic or sedative medication; 13% involved an antipsychotic and 92% a sedative. Factors associated with antipsychotic administration included nursing home residence (adjusted odds ratio [aOR]: 2.67; 95% CI: 1.05-6.80), dementia (aOR: 5.62; 95% CI: 2.44-12.94), and delirium (aOR: 7.33; 95% CI: 2.21-24.32). Sedative administration was positively associated with CT or MR imaging (aOR: 1.86; 95% CI: 1.42-2.43), urbanicity of ED (aOR: 1.46; 95% CI: 1.02-2.08), and female gender (aOR: 1.47; 95% CI: 1.08-1.99) and negatively associated with older age (age: 75-84; aOR: 0.67; 95% CI: 0.49-0.91; age: 85+; aOR: 0.63; 95% CI: 0.45-0.88; reference age: 65-74 years). Antipsychotic and sedative administration were associated with prolonged ED lengths of stay and hospital admission. CONCLUSION We identified patient- and facility-level factors associated with sedative and antipsychotic administration in older ED patients. Antipsychotic and sedative administration were associated with prolonged ED lengths of stay and hospital admission.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Koehl
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katherine A Ciampa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bryan D Hayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Toxicology, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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16
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Dubucs X, Balen F, Charpentier S, Lauque D, De Souto Barreto P, Tavassoli N, Houze-Cerfon CH, Rolland Y. Factors associated with Emergency Medical Dispatcher request and residents' inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med 2021; 13:351-357. [PMID: 34652784 DOI: 10.1007/s41999-021-00574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request. METHODS This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team. RESULTS Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD's decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07-2.93]; p = 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33-0.83]; p = 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33-0.84]; p = 0.007) were associated with a low rate of potentially inappropriate transfer. CONCLUSION Promoting onsite medical assessment and partnership thanks to available geriatrician's advice may help the emergency medical dispatcher to improve the appropriateness of residents' transfer from Nursing Home to the emergency department.
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Affiliation(s)
- Xavier Dubucs
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France.
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Dominique Lauque
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Yves Rolland
- INSERM, U1295, F-31073, Toulouse, France
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
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17
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Swan L, Hullick C, Etherton-Beer C, Arendts G. Holistic approach to undifferentiated acute severe behavioural disturbance in older emergency department patients. Emerg Med Australas 2021; 33:1100-1105. [PMID: 34535981 DOI: 10.1111/1742-6723.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Lachlan Swan
- Department of Emergency Medicine, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carolyn Hullick
- Department of Emergency Medicine, Hunter New England Health Service, Newcastle, New South Wales, Australia.,Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | | | - Glenn Arendts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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18
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Emergent and Non-Emergent Agitation in the Older Adult: Evaluation and Management. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Chary AN, Naik AD, Kennedy M. Visitor policies and health equity in emergency care of older adults. J Am Geriatr Soc 2021; 70:376-378. [PMID: 34310690 DOI: 10.1111/jgs.17392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aanand D Naik
- Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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20
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Arendts G, Hullick C. Droperidol should not be considered first line therapy in acute behavioural disturbance of older patients. Emerg Med Australas 2021; 33:390-391. [PMID: 33561901 DOI: 10.1111/1742-6723.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Glenn Arendts
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Carolyn Hullick
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
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21
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D'cruz M, Sharma A, Damodharan D. Potentially inappropriate medication with syndrome of inappropriate antidiuretic hormone secretion and gastrointestinal bleed in an older adult presenting as a psychiatric emergency. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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