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Shirzad F, Shariat SV, Masjedi N, Ghadirivasfi M, Ghalichi L, Fakhrian A, Hadi F. Workshop-based training of pre-hospital emergency technicians for acute psychiatric patients: benefits and drawbacks. BMC MEDICAL EDUCATION 2024; 24:996. [PMID: 39267028 PMCID: PMC11396583 DOI: 10.1186/s12909-024-05856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 08/01/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Pre-hospital emergency technicians are crucial in managing patients with acute psychiatric symptoms. They must quickly assess the condition, make a primary diagnosis, and refer the patient to the appropriate treatment center. Insufficient skills in these situations can cause serious harm. Educating technicians on dealing with these patients may enhance their knowledge and skills; however, we do not know the extent and longevity of this improvement and which areas are affected. This study investigates the impact of training on pre-hospital emergency technicians' knowledge and skills. METHODS This quasi-experimental study involved pre-hospital emergency technicians in Robat Karim and Nasim Shahr counties from December 2022 to January 2022. The technicians received workshops on interacting with psychiatric patients. The training topics included the basic principles of coping with a psychiatric patient. They also covered a step-by-step approach to dealing with an aggressive patient, dealing with a patient threatening suicide, managing agitation, managing a patient suffering from panic attacks, and finally dealing with a delirious patient. A pre-test assessed their baseline knowledge and skills, followed by a post-test after training and another test three months later. The test results were analyzed. RESULTS This study involved forty male participants ranging in age from 25 to 44 and with work experience ranging from five to twenty years. As a result of training in dealing with acute psychiatric patients, technicians developed significant skills and knowledge immediately after training, and these improvements remained significant three months after training. Nevertheless, the correct answers decreased during the three-month follow-up compared to the pre-test. Education was less effective at managing panic, delirium, and agitation. CONCLUSION In conclusion, technicians' knowledge and skills can be effectively enhanced through training; however, the impact diminishes with time. Theories and practical methods, periodic repetition, and real-world internships are the best ways to maximize training effectiveness.
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Grants
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Vahid Shariat
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Department of Psychiatry, School of Medicine, Tehran Institute of Psychiatry), Tehran, Iran
| | - Neda Masjedi
- Department of psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghadirivasfi
- Medical faculty, Research Center for Addiction and Risky Behaviors (ReCARB), Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghalichi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Arghavan Fakhrian
- Fellowship of Psychosexual Medicine, Department of Psychosexual Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Er AT, Sng LH. Overcoming ageism: Ensuring quality geriatric care during radiology examinations. J Med Imaging Radiat Sci 2023; 54:S32-S37. [PMID: 37741709 DOI: 10.1016/j.jmir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Amanda Tw Er
- Department of Radiology, Changi General Hospital, Singapore; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, VIC 3800, Australia.
| | - Li Hoon Sng
- Department of Radiology, Sengkang General Hospital, Singapore; Health and Social Sciences, Singapore Institute of Technology (SIT), Singapore
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Di Prazza A, Canino B, Barbagallo M, Veronese N. The importance of prognosis in geriatric patients attending the emergency department: a comparison between two common short geriatric assessment tools. Aging Clin Exp Res 2023; 35:3041-3046. [PMID: 37932645 PMCID: PMC10721668 DOI: 10.1007/s40520-023-02603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The use of short geriatric tools in the emergency department (ED) is increasing, but the literature is still conflicting. The aim of this study is to compare the precision and the accuracy of two short geriatric assessment tools to predict mortality in a cohort of older patients attending the ED. METHODS A retrospective study was conducted including patients ≥ 65 years, attending the ED and transferred to a medical assessment unit from February to July 2022. Clinical Frailty Scale (CFS) and Brief Multidimensional Prognostic Index (Brief MPI) were administered. The association between Brief MPI and CFS and mortality was analysed via area under the curve (AUC) with its 95% confidence intervals (CIs), the C-statistics and a multivariate Cox's regression analysis, in the latter case reporting the data as hazard ratios (HRs) with their 95% CI. RESULTS Among the 579 patients enrolled (mean age: 77 years), both Brief MPI and CFS showed a good accuracy in predicting mortality (AUC: 0.72; 95% CI: 0.61-0.83 for Brief MPI; 0.754; 95% CI: 0.65-0.83 for CFS). The discrimination of Brief MPI and CFS in predicting mortality was excellent, since the C-index of the Brief MPI was 0.85 and of CFS = 0.84. In the multivariate analysis, the risk for mortality was significantly increased for frailer subjects (HR 4.65; 95% CI: 1.45-15.00 for Brief MPI > 0.66; HR = 9.24; 95% CI: 1.16-76.90 for CFS > 6). CONCLUSIONS Brief MPI and CFS showed a good accuracy/precision to predict mortality in older patients attending the ED. Considering that they are quick to perform, their introduction in ED clinical practice could be extremely helpful.
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Affiliation(s)
- Agnese Di Prazza
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Baldassare Canino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
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Gagliano M, Bula CJ, Seematter-Bagnoud L, Michalski-Monnerat C, Nguyen S, Carron PN, Mabire C. Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization. BMC Geriatr 2023; 23:642. [PMID: 37817072 PMCID: PMC10565963 DOI: 10.1186/s12877-023-04321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.
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Affiliation(s)
- Mariangela Gagliano
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland.
- Department of Geriatrics, Rehabilitation and Palliative Care, Neuchâtel Hospital Network, Rue du Chasseral 20, La Chaux-de-Fonds, CH-2300, Switzerland.
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Carole Michalski-Monnerat
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, Neuchâtel, CH-2000, Switzerland
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Sylvain Nguyen
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Cédric Mabire
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
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Karmelić E, Lindlöf H, Luckhaus JL, Castillo MM, Vicente V, Härenstam KP, Savage C. Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services. BMC Emerg Med 2023; 23:65. [PMID: 37286931 DOI: 10.1186/s12873-023-00830-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors. METHODS Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis. RESULTS Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries. CONCLUSIONS The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians' journey from novice to expert.
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Affiliation(s)
- Ema Karmelić
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Henrik Lindlöf
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- The ambulance medical service of Region Västmanland, Västerås, Sweden
| | - Jamie Linnea Luckhaus
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Moa Malmqvist Castillo
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- The ambulance medical service in Stockholm (AISAB), Stockholm, Sweden
- Academic EMS, Stockholm, Sweden
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
- Department of Womens and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | - Carl Savage
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen, Stockholm, 18A 171 77, Sweden.
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.
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Karami B, Ostad-Taghizadeh A, Rashidian A, Tajvar M. Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review. Int J Health Policy Manag 2023; 12:7342. [PMID: 37579375 PMCID: PMC10461896 DOI: 10.34172/ijhpm.2023.7342] [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: 04/20/2022] [Accepted: 05/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.
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Affiliation(s)
- Badrye Karami
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostad-Taghizadeh
- Department of Disaster & Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Furlong KR, O'Donnell K, Farrell A, Mercer S, Norman P, Parsons M, Patey C. Older Adults, the "Social Admission," and Nonspecific Complaints in the Emergency Department: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e38246. [PMID: 36920467 PMCID: PMC10132007 DOI: 10.2196/38246] [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: 05/05/2022] [Revised: 11/09/2022] [Accepted: 12/21/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older adults have a higher visit rate and poorer health outcomes in the emergency department (ED) compared to their younger counterparts. Older adults are more likely to require additional resources and hospital admission. The nonspecific, atypical, and complex nature of disease presentation in older adults challenges current ED triage systems. Acute illness in older adults is often missed or commonly disguised in the ED as a social or functional issue. If diagnostic clarity is lacking or safe discharge from the ED is not feasible, then older adults may be labelled a "social admission" (or another synonymous term), often leading to negative health consequences. OBJECTIVE This scoping review aims to describe and synthesize the available evidence on patient characteristics, adverse events, and health outcomes for older adults labelled as "social admission" (and other synonymously used terms), as well as those with nonacute or nonspecific complaints in the ED or hospital setting. METHODS A literature search of MEDLINE, Embase, Scopus, PsycINFO, and CINAHL was completed. Relevant reference lists were screened. Data have been managed using EndNote software and the Covidence web application. Original data have been included if patients are aged ≥65 years and are considered a "social admission" (or other synonymously used term) or if they present to the ED with a nonacute or nonspecific complaint. Two review team members have reviewed titles and abstracts and will review full-text articles. Disagreements are resolved by consensus or in discussion with a third reviewer. This review does not require research ethics approval. RESULTS As of January 2023, we have completed the title and abstract screening and have started the full-text screening. Some remaining full-text articles are being retrieved and/or translated. We are extracting data from included studies. Data will be presented in a narrative and descriptive manner, summarizing key concepts, patient characteristics, and health outcomes of patients labelled as a "social admission" (and other synonymously used terms) and of those with nonacute and nonspecific complaints. We expect the first results for publication in Spring 2023. CONCLUSIONS Acute illness in the older adult is not always easily identified. We hope to better understand patient characteristics, adverse events, and health outcomes of older adults labelled as a "social admission," as well as those with nonacute or nonspecific complaints. We aim to identify priorities for future research and identify knowledge gaps that may inform health care providers caring for these vulnerable patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38246.
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Affiliation(s)
- Kayla Rose Furlong
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Kathleen O'Donnell
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Alison Farrell
- Health Sciences Library, Memorial University Libraries, Memorial University, St John's, NL, Canada
| | - Susan Mercer
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Paul Norman
- Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
| | - Michael Parsons
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Discipline of Emergency Medicine, Faculty of Medicine, Memorial University, St John's, NL, Canada.,Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear, NL, Canada
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Venema D, Vervoort SCJM, de Man-van Ginkel JM, Bleijenberg N, Schoonhoven L, Ham WHW. What are the needs of frail older patients in the emergency department? A qualitative study. Int Emerg Nurs 2023; 67:101263. [PMID: 36773515 DOI: 10.1016/j.ienj.2023.101263] [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: 09/29/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND There is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission. METHOD A qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed. RESULTS The analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences. CONCLUSION Frail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.
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Affiliation(s)
- Dorien Venema
- University of Applied Sciences, Institute of Nursing Studies, PO Box 12011, 3501 AA Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Sigrid C J M Vervoort
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; Academic Nursing, Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - Nienke Bleijenberg
- University of Applied Sciences, Research Group for Older People Living at Home, PO Box 12011, 3501 AA Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southhampton S017 1BJ, United Kingdom.
| | - Wietske H W Ham
- University of Applied Sciences, Research Group for Older People Living at Home, PO Box 12011, 3501 AA Utrecht, the Netherlands.
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Santangelo I, Ahmad S, Liu S, Southerland LT, Carpenter C, Hwang U, Lesser A, Tidwell N, Biese K, Kennedy M. Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments. JOURNAL OF GERIATRIC EMERGENCY MEDICINE 2023; 3:10.17294/2694-4715.1041. [PMID: 36970655 PMCID: PMC10035774 DOI: 10.17294/2694-4715.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
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.
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Affiliation(s)
- Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Surriya Ahmad
- SUNY Downstate Medical Center / Kings County Hospital Center
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | | | - Christopher Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY
| | | | | | - Kevin Biese
- West Health Institute, La Jolla, CA; Division of Geriatric Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
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Cobb S, Bazargan M, Assari S, Barkley L, Bazargan-Hejazi S. Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults. J Racial Ethn Health Disparities 2023; 10:205-218. [PMID: 35006585 PMCID: PMC8744566 DOI: 10.1007/s40615-021-01211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. METHODS Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. RESULTS African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. DISCUSSION Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.
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Affiliation(s)
- Sharon Cobb
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA USA
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Department of Public Health, CDU, Los Angeles, CA USA
- Physician Assistant Program, CDU, Los Angeles, CA USA
- Department of Family Medicine, UCLA, Los Angeles, CA USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
- Department of Public Health, CDU, Los Angeles, CA USA
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
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Rueegg M, Nissen SK, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, Bingisser R, Nickel CH. The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older. Acad Emerg Med 2022; 29:572-580. [PMID: 35138670 PMCID: PMC9320818 DOI: 10.1111/acem.14460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To validate the Clinical Frailty Scale (CFS) for prediction of 1-year all-cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI). METHODS Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged ≥65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS. RESULTS In the final study population of 2191 patients, 1-year all-cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741-0.793), compared to 0.703 (95% CI: 0.673-0.732) for the adjusted ESI model. CONCLUSION The CFS predicts 1-year all-cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.
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Affiliation(s)
- Marco Rueegg
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Søren Kabell Nissen
- Institute of Regional Health Research, Centre South‐West JutlandUniversity of Southern DenmarkOdenseDenmark
| | - Mikkel Brabrand
- Institute of Regional Health Research, Centre South‐West JutlandUniversity of Southern DenmarkOdenseDenmark
- Department of Emergency MedicineOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Tobias Kaeppeli
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Thomas Dreher
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christopher R. Carpenter
- Department of Emergency MedicineWashington University in St. Louis School of Medicine, Emergency Care Research CoreSt. LouisMichiganUSA
| | - Roland Bingisser
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christian H. Nickel
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
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12
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Cai M, Wang Z, Gu H, Dong H, Zhang X, Cui N, Zhou L, Chen G, Zou G. Occurrence and temporal variation of antibiotics and antibiotic resistance genes in hospital inpatient department wastewater: Impacts of daily schedule of inpatients and wastewater treatment process. CHEMOSPHERE 2022; 292:133405. [PMID: 34958787 DOI: 10.1016/j.chemosphere.2021.133405] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
The temporal variation of antibiotics and ARGs as well as the impact of daily schedule of inpatients on their regular occurrence in hospital wastewater (HWW) were previously obscure. In this study, the wastewater of the inpatient department pre- and posttreatment (hydraulic retention time = 8 h) was collected intraday and intraweek. The absolute concentrations of antibiotics/metabolites and ARGs in HWW were analyzed to investigate the temporal variations of their occurrence levels. Fluoroquinolones were the predominant drugs used in the inpatient department (681.30-881.66 ng/mL in the effluent) and the main contaminant in the outlet of the disinfection pond (538.29-671.47 ng/mL). Diurnal variations peaked at 19:00 for most antibiotics and ARGs, while the maximum of them occurred on weekends. Aminoglycoside resistance genes (AMRGs, 21.6-23000 copies/mL) and β-lactam resistance genes (BLGRs, 1.24-8500 copies/mL) were the dominant ARGs before and after treatment processing, respectively (p < 0.05). The significant removal rates (>50%) of most antibiotics and ARGs, as well as the integrase gene intI1 and 16S rRNA gene, were found to be subjected solely to the chloride disinfection process, suggesting the necessity of the self-contained wastewater treatment process. Meanwhile, the statistically significant correlation among antibiotics, ARGs, intI1, and 16S rRNA (p < 0.05) demonstrated that the risk of selective pressure, horizontal transfer and vertical propagation of ARGs in the effluent of the hospital was warranted. Principal component analysis (PCA) showed that the daily schedule of inpatients and wastewater treatment processes could markedly induce fluctuations in antibiotic and ARG levels in HWW, indicating that they should be considered an impact factor for environmental monitoring. This study demonstrated for the first time the temporal variations in the abundance and dissemination of antibiotics and ARGs in a semiclosed zone and provided new insight into the development of assessments of the associated ecological risk and human health.
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Affiliation(s)
- Min Cai
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Zhenglu Wang
- College of Oceanography, Hohai University, Nanjing, Jiangsu, 210024, PR China.
| | - Haotian Gu
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China
| | - Hui Dong
- Agro-food Standards and Testing Technology Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China
| | - Xu Zhang
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Naxin Cui
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Li Zhou
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Guifa Chen
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China
| | - Guoyan Zou
- Eco-environmental Protection Research Institute, Shanghai Academy of Agricultural Science, Shanghai, 201403, PR China; Shanghai Engineering Research Center of Low-carbon Agriculture (SERCLA), Shanghai, 201415, PR China.
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Zhang M, Zhang X, Gao L, Yue J, Jiang X. Incidence, predictors and health outcomes of delirium in very old hospitalized patients: a prospective cohort study. BMC Geriatr 2022; 22:262. [PMID: 35351018 PMCID: PMC8966247 DOI: 10.1186/s12877-022-02932-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background Delirium is a common complication that leads to poor health outcomes in older patients undergoing treatment. Due to severe consequences, early recognition of high-risk patients and risk factors for delirium are crucial in the prompt initiation of prevention measures. However, research in medically hospitalized patients aged ≥80 years remains limited. This study aimed to determine the incidence, predictors and health outcomes of delirium in very old (aged ≥80 years) hospitalized patients in China. Methods A prospective study was conducted in individuals aged ≥80 years admitted to geriatric departments. Potential risk factors were assessed within 24 h after hospital admission. Screening for delirium was performed on admission and every 48 h thereafter for 14 days and assessed if acute mental status changes were observed. During hospitalization, health outcomes were recorded daily. Results Incident delirium occurred in 109 of 637 very old hospitalized patients (17.1%). The independent predictors of delirium in hospitalized patients aged 80 and over were cognitive function impairment [OR 17.42, 95% CI:(7.47–40.64)], depression [OR 9.30, 95% CI: (4.59–18.84)], CCI ≥ 5 [OR 4.21, 95% CI: (1.48–12.01)], sleep deprivation [OR 3.89, 95% CI: (1.71–8.82)], infection [OR 3.33, 95% CI: (1.70–6.54)], polypharmacy (≥5 medications) [OR 2.85, 95% CI: (1.51–5.39)], constipation [OR 2.58, 95% CI: (1.33–5.02)], and emergency admission [OR 2.13, 95% CI: (1.02–4.45)]. Patients with delirium had significantly longer hospital stays(P < 0.001) and higher percentages of physical restraint use(P < 0.001) and falls (P = 0.001) than those without delirium,. Conclusion The incidence of delirium was high in hospitalized patients aged ≥80 years admitted to the geriatric department and was associated with prolonged hospital stay and higher rates of physical restraint use and falls. In this population, the most important independent risk factors for incident delirium were cognitive function impairment and depression. Health care professionals should recognize and initiate interventions for delirium early in geriatric patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02932-9.
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Affiliation(s)
- Meng Zhang
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xuemei Zhang
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Langli Gao
- West China School of Nursing, Sichuan University/ Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaolian Jiang
- West China School of Nursing, Sichuan University, Chengdu, NO. 37 GuoXue Road, Chengdu, 610041, Sichuan province, China.
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14
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Lee JE, Kim D, Kahana E, Kahana B. Feasibility and acceptability of the community-based program: Plan Ahead. Aging Ment Health 2022; 27:811-819. [PMID: 35285774 DOI: 10.1080/13607863.2022.2046692] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level. METHODS In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities. RESULTS Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group. CONCLUSION Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.
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Affiliation(s)
- Jeong Eun Lee
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Dahee Kim
- Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Boaz Kahana
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
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15
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Mooijaart SP, Carpenter CR, Conroy SP. Geriatric emergency medicine-a model for frailty friendly healthcare. Age Ageing 2022; 51:6550832. [PMID: 35307733 DOI: 10.1093/ageing/afab280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
As the world's population continues to age over the decades ahead, medical educators and researchers in every adult medical and surgical specialty will need to 'geriatricise' their clinical science. Many have already engaged with geriatrics. Here we describe the progress that has been made and the opportunities ahead in the field of Geriatric Emergency Medicine (GEM), a field that has taken large steps in integrating holistic care. Future opportunities exist in the three domains of evidence-based medicine: including patient preferences and needs, generating scientific evidence, and improving physician knowledge and expertise. Implementation requires new innovations also in the organisation of care. Similar strategies may be useful in other fields of medicine, in making holistic care the standard for older people.
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Affiliation(s)
- Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christopher R Carpenter
- Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Simon P Conroy
- UCL MRC Unit for Lifelong Health and Ageing at UCL 5th Floor, 1-19 Torrington Place, London, WC1E7HB, UK
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16
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Hullick C, Conway J, Hall A, Murdoch W, Cole J, Hewitt J, Oldmeadow C, Attia J. Video-telehealth to support clinical assessment and management of acutely unwell older people in Residential Aged Care: a pre-post intervention study. BMC Geriatr 2022; 22:40. [PMID: 35012480 PMCID: PMC8744579 DOI: 10.1186/s12877-021-02703-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people living in Residential Aged Care (RAC) are at high risk of clinical deterioration. Telehealth has the potential to provide timely, patient-centred care where transfer to hospital can be a burden and avoided. The extent to which video telehealth is superior to other forms of telecommunication and its impact on management of acutely unwell residents in aged care facilities has not been explored previously. METHODS In this study, video-telehealth consultation was added to an existing program, the Aged Care Emergency (ACE) program, aiming at further reducing Emergency Department (ED) visits and hospital admissions. This controlled pre-post study introduced video-telehealth consultation as an additional component to the ACE program for acutely unwell residents in RACs. Usual practice is for RACs and ACE to liaise via telephone. During the study, when the intervention RACs called the ED advanced practice nurse, video-telehealth supported clinical assessment and management. Five intervention RACs were compared with eight control RACs, all of whom refer to one community hospital in regional New South Wales, Australia. Fourteen months pre-video-telehealth was compared with 14 months post-video-telehealth using generalized linear mixed models for hospital admissions after an ED visit and ED visits. One thousand two hundred seventy-one ED visits occurred over the 28-month study period with 739 subsequent hospital admissions. RESULTS There were no significant differences in hospital admission or ED visits after the introduction of video-telehealth; adjusted incident rate ratios (IRR) were 0.98 (confidence interval (CI) 0.55 to 1.77) and 0.89 (95% CI 0.53 to 1.47) respectively. CONCLUSIONS Video-telehealth did not show any incremental benefit when added to a structured hospital avoidance program with nursing telephone support. TRIAL REGISTRATION The larger Aged Care Emergency evaluation is registered with ANZ Clinical Trials Registry, ACTRN12616000588493.
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Affiliation(s)
- Carolyn Hullick
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. .,Belmont Hospital, Hunter New England Local Health District, Belmont, Australia. .,Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Jane Conway
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Wendy Murdoch
- Belmont Hospital, Hunter New England Local Health District, Belmont, Australia
| | | | - Jacqueline Hewitt
- Hunter New England Central Coast Primary Health Network, Newcastle West, Australia
| | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, New Lambton Heights, NSW, 2310, Australia
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Celiński M, Cybulski M, Fiłon J, Muszalik M, Goniewicz M, Krajewska-Kułak E, Ślifirczyk A. Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:48. [PMID: 35010308 PMCID: PMC8744554 DOI: 10.3390/ijerph19010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to analyse medical management in geriatric patients in the Hospital Emergency Departments in the Biała Podlaska County and Chełm County (Poland) between 2016 and 2018 in a group of patients ≥65 years of age. We analysed medical records of 829 patients transported to Hospital Emergency Departments by Medical Emergency Teams. The research was conducted in the period from June 2019 to March 2020. We analysed emergency medical procedure forms and medical records of patients transported to the hospitals. Cardiovascular diseases were diagnosed in 40% of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the Hospital Emergency Departments in more than 2/3 of cases. The concordance between the diagnoses made by the Medical Emergency Teams and those made at the Hospital Emergency Departments was confirmed for 78% patients admitted to the department (n = 647), whereas the concordance of classification at the group level was estimated at 71.7% (n = 594). Further in-patient treatment was initiated in some of the patients admitted to the department (n = 385). The mean time of hospital stay was 10.1 days. In conclusion, differences between the initial diagnosis made by the heads of the Medical Emergency Teams and the diagnosis made by the doctor on duty in the Hospital Emergency Departments depended on the chapter of diseases in the ICD-10 classification, but they were acceptable. The majority of the patients were transported to Hospital Emergency Departments. The most common groups of diseases that require Hospital Emergency Departments admission include cardiovascular diseases, injuries due to external causes, and respiratory diseases. A moderate percentage of patients were qualified for further specialist treatment in hospital departments.
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Affiliation(s)
- Mariusz Celiński
- Department of Emergency Medicine, Faculty of Health Sciences, Pope John Paul II State School of Higher Education in Biała Podlaska, 21-500 Biała Podlaska, Poland; (M.C.); (A.Ś.)
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Joanna Fiłon
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus in Toruń, 85-094 Bydgoszcz, Poland;
| | - Mariusz Goniewicz
- Interfaculty Centre for Didactics, Department of Emergency Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Elżbieta Krajewska-Kułak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Białystok, 15-096 Białystok, Poland; (J.F.); (E.K.-K.)
| | - Anna Ślifirczyk
- Department of Emergency Medicine, Faculty of Health Sciences, Pope John Paul II State School of Higher Education in Biała Podlaska, 21-500 Biała Podlaska, Poland; (M.C.); (A.Ś.)
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Ghneim MH, Kufera JA, Clark J, Harfouche MN, Hendrix CJ, Diaz JJ. Emergency General Surgery Procedures and Cost of Care for Older Adults in the State of Maryland. Am Surg 2021; 88:439-446. [PMID: 34732080 DOI: 10.1177/00031348211048838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older adults (OAs) ≥ 65 years of age, representing the fastest growing segment in the United States, are anticipated to require a greater percentage of emergency general surgery procedures (EGSPs) with an associated increase in health care costs. The aims of this study were to identify the frequency of EGSP and charges incurred by OA compared to their younger counterparts in the state of Maryland. METHODS A retrospective review of the Maryland Health Services Cost Review Commission from 2009 to 2018 was undertaken. Patients undergoing urgent or emergent ESGP were divided into 2 groups (18-64 years and ≥65 years). Data collected included demographics, APR-severity of illness (SOI), APR-risk of mortality (ROM), the EGSP (partial colectomy [PC], small bowel resection [SBR], cholecystectomy, operative management of peptic ulcer disease, lysis of adhesions, appendectomy, and laparotomy), length of stay (LOS), and hospital charges. P-values (P < .05) were significant. RESULTS Of the 181,283 patients included in the study, 55,401 (38.1%) were ≥65 years of age. Older adults presented with greater APR-SOI (major 37.7% vs 21.3%, extreme 5.2% vs 9.3%), greater APR-ROM (major 25.3% vs 8.7%, extreme 22.3% vs 5.3%), underwent PC (24.5% vs 10.9%) and SBR (12.8% vs 7.0%) more frequently, and incurred significantly higher median hospital charges for every EGSP, consistently between 2009 and 2018 due to increased LOS and complications when compared to those ≤65 years of age. CONCLUSION These findings stress the need for validated frailty indices and quality improvement initiatives focused on the care of OAs in emergency general surgery to maximize outcomes and optimize cost.
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Affiliation(s)
- Mira H Ghneim
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, 137889University of Maryland Medical Center, Baltimore, MD, USA
| | - Joseph A Kufera
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, 137889University of Maryland Medical Center, Baltimore, MD, USA
| | - Jaclyn Clark
- National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melike N Harfouche
- National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cheralyn J Hendrix
- Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, 137889University of Maryland Medical Center, Baltimore, MD, USA
| | - Jose J Diaz
- National Study Center for Trauma and Emergency Medical Systems, Center for Shock, Trauma and Anesthesiology Research, 12264University of Maryland School of Medicine, Baltimore, MD, USA
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Eichinger M, Robb HDP, Scurr C, Tucker H, Heschl S, Peck G. Challenges in the PREHOSPITAL emergency management of geriatric trauma patients - a scoping review. Scand J Trauma Resusc Emerg Med 2021; 29:100. [PMID: 34301281 PMCID: PMC8305876 DOI: 10.1186/s13049-021-00922-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group. METHODS AND FINDINGS A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review. CONCLUSIONS Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.
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Affiliation(s)
- Michael Eichinger
- Major Trauma and Cutrale Perioperative and Ageing Group, Imperial College Healthcare NHS Trust, London, UK
| | - Henry Douglas Pow Robb
- Academic Clinical Fellow in General Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Cosmo Scurr
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | | | - Stefan Heschl
- Department of Cardiac, Thoracic and Vascular Anaesthesiology and Intensive Care, Medical University Hospital, Graz, Austria
| | - George Peck
- Cutrale Peri-operative and Ageing Group, Imperial College London, London, UK
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Kang Y, Zhang GC, Zhu JQ, Fang XY, Niu J, Zhang Y, Wang XJ. Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery: An observational cohort study. Medicine (Baltimore) 2021; 100:e26056. [PMID: 34087847 PMCID: PMC8183836 DOI: 10.1097/md.0000000000026056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/30/2021] [Indexed: 01/04/2023] Open
Abstract
Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0-20, BI 21-40, BI 41-60, BI 61-80 and BI 81-100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20-1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638-0.771). Kaplan-Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.
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Affiliation(s)
- Yu Kang
- Department of Geriatric Medicine
| | | | - Ji-Qiao Zhu
- Department of Liver and Gallbladder Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | | | - Jing Niu
- Department of Geriatric Medicine
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Abstract
Geriatric emergency medicine has emerged as a subspecialty of emergency medicine over the past 25 years. This emergence has seen the development of increases in training opportunities, care delivery strategies, collaborative best practice guidelines, and formal geriatric emergency department accreditation. This multidisciplinary field remains ripe for continued development in the coming decades as the aging US population parallels a call from patients, health care providers, and health systems to improve the delivery of high-value care. This article educates emergency medicine practitioners and highlights high-value care practice trends to inform and prioritize decision-making for this unique patient population.
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Kim K, Jung J, Kim H, Kim JT, Oh JM, Kim H. Potentially Inappropriate Prescriptions to Older Patients in Emergency Departments in South Korea: A Retrospective Study. Ther Clin Risk Manag 2021; 17:173-181. [PMID: 33642859 PMCID: PMC7903959 DOI: 10.2147/tcrm.s291458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the incidence of the administration of potentially inappropriate medications (PIMs) and the potential drug–drug interactions (pDDIs) in older patients in emergency departments (EDs) over a 12-month period and to identify the factors associated with the administration of PIMs. Patients and Methods This retrospective study was conducted using the electronic medical records from two university-affiliated teaching hospitals in South Korea. ED visit cases of patients aged 65 and older from January 1, 2013, to December 31, 2013, were included in the analysis. Among the medications administered in ED, PIMs or pDDIs were identified using a drug utilization review program available in Korea. Results During the study period, a total of 13,002 ED visit cases were reported from 10,686 patients. The proportion of ED visit cases with any PIM was 79.2% and the average number of PIMs was 2.7 (range, 1–17). The most commonly administered PIMs that were contraindicated or should have been used with caution were ketorolac (41.3%) and metoclopramide (10.3%), respectively. Multivariate regression analysis indicated that female patients (p = 0.012), patients with more than six drugs in the ED (p < 0.001), and visits longer than 300 minutes (p = 0.026) were significantly associated with PIM administration in the ED. Potential DDIs between the medications administered in EDs were observed in 20.5% of total visit cases, with ketorolac being the most frequently reported drug in contraindicated drug combinations. Conclusion This study demonstrated a high incidence of the administration of PIMs and medications with pDDIs in older patients in EDs and revealed the characteristics that are significantly associated with an increased risk of PIM administration. Healthcare providers in EDs should consider the risk of administering PIMs or medications with pDDIs, especially when treating older patients.
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Affiliation(s)
- Kyungim Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea.,Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Jinyoung Jung
- Institute of Pharmaceutical Science, Korea University, Sejong, Republic of Korea
| | - Haesook Kim
- Department of Pharmacy, Gang Neung Asan Hospital, Gangneung, Republic of Korea
| | - Jung Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea.,Drug Information Research Institute, College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
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Tay HS, Wood AD, Carter B, Pearce L, McCarthy K, Stechman MJ, Myint PK, Hewitt J. Impact of Surgery on Older Patients Hospitalized With an Acute Abdomen: Findings From the Older Persons Surgical Outcome Collaborative. Front Surg 2020; 7:583653. [PMID: 33282905 PMCID: PMC7705344 DOI: 10.3389/fsurg.2020.583653] [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: 07/15/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The impact of surgery compared to non-surgical management of older general surgical patients is not well researched. Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged > 65 years. This multi-center study included 727 patients (mean+/-SD, 77.1 ± 8.2 years, 54% female) admitted to five UK hospitals. Data were analyzed using multi-level crude and multivariable logistic regression. Outcomes were: mortality at Day 30 and 90, length of stay, and readmission within 30 days of discharge. Covariates assessed were management approach, age, sex, frailty, polypharmacy, anemia, and hypoalbuminemia. Results: Approximately 25% of participants (n = 185) underwent emergency surgery. Frailty and albumin were associated with mortality at 30 (frailty OR = 3.52 [95% CI 1.66–7.49], albumin OR = 3.78 ([95% CI 1.53–9.31]), and 90 days post discharge (frailty OR = 3.20 [95% CI 1.86–5.51], albumin OR=3.25 [95% CI 1.70–6.19]) and readmission (frailty OR = 1.56 [95% CI (1.04–2.35)]). Surgically managed patients and frailty had increased odds of prolonged hospitalization (surgery OR = 5.69 [95% CI 3.67–8.80], frailty OR = 2.17 [95% CI 1.46–3.23]). Conclusion: We found the impact of surgery on length of hospitalization in older surgical patients is substantial. Whether early comprehensive geriatric assessment and post-op rehabilitation would improve this outcome require further evaluation.
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Affiliation(s)
- Hui Sian Tay
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Adrian D Wood
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College, London, United Kingdom
| | - Lyndsay Pearce
- Department of General Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Kathryn McCarthy
- Department of General Surgery, North Bristol National Health Service (NHS) Trust, Bristol, United Kingdom
| | - Michael J Stechman
- Department of General Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Phyo K Myint
- Department of Geriatric Medicine, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jonathan Hewitt
- Department of Geriatric Medicine, Cardiff University, Cardiff, United Kingdom
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Joseph JW, Kennedy M, Nathanson LA, Wardlow L, Crowley C, Stuck A. Reducing Emergency Department Transfers from Skilled Nursing Facilities Through an Emergency Physician Telemedicine Service. West J Emerg Med 2020; 21:205-209. [PMID: 33207167 PMCID: PMC7673904 DOI: 10.5811/westjem.2020.7.46295] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/11/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Transfers of skilled nursing facility (SNF) residents to emergency departments (ED) are linked to morbidity, mortality and significant cost, especially when transfers result in hospital admissions. This study investigated an alternative approach for emergency care delivery comprised of SNF-based telemedicine services provided by emergency physicians (EP). We compared this on-site emergency care option to traditional ED-based care, evaluating hospital admission rates following care by an EP. Methods We conducted a retrospective, observational study of SNF residents who underwent emergency evaluation between January 1, 2017–January 1, 2018. The intervention group was comprised of residents at six urban SNFs in the Northeastern United States, who received an on-demand telemedicine service provided by an EP. The comparison group consisted of residents of SNFs that did not offer on-demand services and were transferred via ambulance to the ED. Using electronic health record data from both the telemedicine and ambulance transfers, our primary outcome was the odds ratio (OR) of a hospital admission. We also conducted a subanalysis examining the same OR for the three most common chronic disease-related presentations found among the telemedicine study population. Results A total of 4,606 patients were evaluated in both the SNF-based intervention and ED-based comparison groups (n=2,311 for SNF based group and 2,295 controls). Patients who received the SNF-based acute care were less likely to be admitted to the hospital compared to patients who were transferred to the ED in our primary and subgroup analyses. Overall, only 27% of the intervention group was transported to the ED for additional care and presumed admission, whereas 71% of the comparison group was admitted (OR for admission = 0.15 [9% confidence interval, 0.13–0.17]). Conclusion The use of an EP-staffed telemedicine service provided to SNF residents was associated with a significantly lower rate of hospital admissions compared to the usual ED-based care for a similarly aged population of SNF residents. Providing SNF-based care by EPs could decrease costs associated with hospital-based care and risks associated with hospitalization, including cognitive and functional decline, nosocomial infections, and falls.
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Affiliation(s)
- Joshua W Joseph
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Maura Kennedy
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Larry A Nathanson
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | | | | | - Amy Stuck
- West Health Institute, La Jolla, California
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Berning MJ, Oliveira J E Silva L, Suarez NE, Walker LE, Erwin P, Carpenter CR, Bellolio F. Interventions to improve older adults' Emergency Department patient experience: A systematic review. Am J Emerg Med 2020; 38:1257-1269. [PMID: 32222314 DOI: 10.1016/j.ajem.2020.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 01/17/2023] Open
Abstract
STUDY OBJECTIVE To summarize interventions that impact the experience of older adults in the emergency department (ED) as measured by patient experience instruments. METHODS This is a systematic review to evaluate interventions aimed to improve geriatric patient experience in the ED. We searched Ovid CENTRAL, Ovid EMBASE, Ovid MEDLINE and PsycINFO from inception to January 2019. The main outcome was patient experience measured through instruments to assess patient experience or satisfaction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the confidence in the evidence available. RESULTS The search strategy identified 992 studies through comprehensive literature search and hand-search of reference lists. A total of 21 studies and 3163 older adults receiving an intervention strategy aimed at improve patient experience in the ED were included. Department-wide interventions, including geriatric ED and comprehensive geriatric assessment unit, focused care coordination with discharge planning and referral for community services, were associated with improved patient experience. Providing an assistive listening device to those with hearing loss and having a pharmacist reviewing the medication list showed an improved patient perception of quality of care provided. The confidence in the evidence available for the outcome of patient experience was deemed to be very low. CONCLUSION While all studies reported an outcome of patient experience, there was significant heterogeneity in the tools used to measure it. The very low certainty in the evidence available highlights the need for more reliable tools to measure patient experience and studies designed to measure the effect of the interventions.
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Affiliation(s)
- Michelle J Berning
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Laura E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Patricia Erwin
- Mayo Clinic Libraries, Rochester, MN, United States of America
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, MO, United States of America
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States of America.
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DeDonato E, Hall SE, Hogan TM, Gleason LJ. Interprofessional Education of Emergency Department Team on Falls in Older Adults. J Am Geriatr Soc 2020; 68:E7-E9. [PMID: 32031237 DOI: 10.1111/jgs.16358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Emily DeDonato
- Department of Medicine, Section of Emergency Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Stephen E Hall
- Department of Medicine, Section of Emergency Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Teresita M Hogan
- Department of Medicine, Section of Emergency Medicine, The University of Chicago Medicine, Chicago, Illinois.,Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago Medicine, Chicago, Illinois
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27
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Gillespie SM, Wasserman EB, Wood NE, Wang H, Dozier A, Nelson D, McConnochie KM, Shah MN. High-Intensity Telemedicine Reduces Emergency Department Use by Older Adults With Dementia in Senior Living Communities. J Am Med Dir Assoc 2019; 20:942-946. [PMID: 31315813 DOI: 10.1016/j.jamda.2019.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. We evaluated the effect of a high-intensity telemedicine program that delivers care for acute illnesses on ED use rates for individuals with dementia who reside in senior living communities (SLCs; independent and assisted living). DESIGN We performed a secondary analysis of data for patients with dementia from a prospective cohort study over 3.5 years that evaluated the effectiveness of high-intensity telemedicine for acute illnesses among SLC residents. SETTING AND PARTICIPANTS We studied patients cared for by a primary care geriatrics practice at 22 SLCs in a northeastern city. Six SLCs were selected as intervention facilities and had access to patient-to-provider high-intensity telemedicine services to diagnose and treat illnesses. Patients at the remaining 15 SLCs served as controls. Participants were considered to have dementia if they had a diagnosis of dementia on their medical record problem list, were receiving medications for the indication of dementia, or had cognitive testing consistent with dementia. MEASURES We compared the rate of ED use among participants with dementia and access to high-intensity telemedicine services to control participants with dementia but without access to services. RESULTS Intervention group participants had 201 telemedicine visits. In participants with dementia, it is estimated that 1 year of access to telemedicine services is associated with a 24% decrease in ED visits (rate ratio 0.76, 95% confidence interval 0.61, 0.96). CONCLUSIONS/IMPLICATIONS Telemedicine in SLCs can effectively decrease ED use by individuals with dementia, but further research is needed to confirm this secondary analysis and to understand how to best implement and optimize telemedicine for patients with dementia suffering from acute illnesses.
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Affiliation(s)
- Suzanne M Gillespie
- Geriatrics and Extended Care, Canandaigua VA Medical Center, Canandaigua, NY; Department of Medicine, Division of Geriatrics & Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Erin B Wasserman
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Nancy E Wood
- Datalys Center for Sports Injury Research and Prevention, Inc, Indianapolis, IN
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Dallas Nelson
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kenneth M McConnochie
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Medicine (Geriatrics & Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Larsson G, Strömberg U, Rogmark C, Nilsdotter A. Cognitive status following a hip fracture and its association with postoperative mortality and activities of daily living: A prospective comparative study of two prehospital emergency care procedures. Int J Orthop Trauma Nurs 2019; 35:100705. [PMID: 31324592 DOI: 10.1016/j.ijotn.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early assessment of hip fracture patients' cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. METHODS Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. RESULTS No difference in patients' cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). CONCLUSION PFTC did not influence hip fracture patients' cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
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Affiliation(s)
- Glenn Larsson
- Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden.
| | - Ulf Strömberg
- Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
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Jacobsohn GC, Hollander M, Beck AP, Gilmore-Bykovskyi A, Werner N, Shah MN. Factors Influencing Emergency Care by Persons With Dementia: Stakeholder Perceptions and Unmet Needs. J Am Geriatr Soc 2019; 67:711-718. [PMID: 30624765 PMCID: PMC6458085 DOI: 10.1111/jgs.15737] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES People with dementia (PwD) frequently use emergency care services. To mitigate the disproportionately high rate of emergency care use by PwD, an understanding of contributing factors driving reliance on emergency care services and identification of feasible alternatives are needed. This study aimed to identify clinician, caregiver, and service providers' views and experiences of unmet needs leading to emergency care use among community-dwelling PwD and alternative ways of addressing these needs. DESIGN Qualitative, employing semistructured interviews with clinicians, informal caregivers, and aging service providers. SETTING Wisconsin, United States. PARTICIPANTS Informal caregivers of PwD (n = 4), emergency medicine physicians (n = 4), primary care physicians (n = 5), geriatric healthcare providers (n = 5), aging service providers (n = 6), and community paramedics (n = 3). MEASUREMENTS Demographic characteristics of participants and data from semistructured interviews. FINDINGS Four major themes were identified from interviews: (1) system fragmentation influences emergency care use by PwD, (2) informational, decision-making, and social support needs influence emergency care use by PwD, (3) emergency departments (EDs) are not designed to optimally address PwD and caregiver needs, and (4) options to prevent and address emergency care needs of PwD. CONCLUSION Participants identified numerous system and individual-level unmet needs and offered many recommendations to prevent or improve ED use by PwD. These novel findings, aggregating the perspectives of multiple dementia-care stakeholder groups, serve as the first step to developing interventions that prevent the need for emergency care or deliver tailored emergency care services to this vulnerable population through new approaches. J Am Geriatr Soc 67:711-718, 2019.
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Affiliation(s)
- Gwen Costa Jacobsohn
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew Hollander
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Aaron P Beck
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Nicole Werner
- College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, Wisconsin
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin
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Aprahamian I, Aricó de Almeida GV, de Vasconcellos Romanin CF, Gomes Caldas T, Antunes Yoshitake NT, Bataglini L, Mori Lin S, Alves Pereira A, Nara Alegrini Longhi L, Mamoni RL, Martinelli JE. Frailty Could Predict Death in Older Adults after Admissionat Emergency Department? A 6-month Prospective Study from a Middle-Income Country. J Nutr Health Aging 2019; 23:641-647. [PMID: 31367729 DOI: 10.1007/s12603-019-1207-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The number of older adults attending emergency department (ED) is increasing all over the world. Usually, those patients are potentially more complex due to their greater number of comorbidities, cognitive disorders, and functional or physical disabilities. Frailty is a vulnerable state that could predict adverse outcomes of those patients. There are very few studies that addressed this topic in the ED, and none of them used a simple instrument for frailty assessment. OBJECTIVES The primary outcome was to evaluate the association between frailty identified through the FRAIL questionnaire at baseline and death after a 6-month follow-up period after hospital discharge from the ED. Secondary outcomes were readmission to the ED and disability after 6 months. METHODS A 6-month follow-up prospective study (FASES study) was conducted at a university-based trauma-center ED in Jundiaí, southwestern of Brazil. A total of 316 older adults aged 60 or older were randomly included based on a lottery of their medical record admission number. Frailty was evaluated through the FRAIL questionnaire. The association between frailty and death was estimated through a binary logistic regression adjusted for age, sex, and cognitive performance. RESULTS From the total sample, the mean age was 72.11±8.0 years, and 51.6% were women. Participants presented 2.28±1.4 comorbidities and 25.6% were frail. Mean hospital stay was 5.43±5.6 days. Death occurred in 52 participants, readmission to the emergency in 55, and new disability in 16 after 6 months. Frailty was associated with an odds ratio of 2.18 for death after 6 months (95% CI = 1.10-4.31; p = 0.024). This association lost significance after multivariate analysis taking into account cognitive performance. There was no association between frailty status at baseline and readmission to the ED or disability. CONCLUSION The identification of frailty using the FRAIL at admission was not predictive of death after a 6-month period after discharge from the ED. Simple frailty assessment could identify patients at higher risk for death in the follow-up.
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Affiliation(s)
- I Aprahamian
- Ivan Aprahamian, MD, MS, PhD, FACP. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, Brazil. 250 Francisco Telles street. ZIP 13.202-550. E-mail:
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Azarkhavarani MG, Alavi NM. Surveying the quality of prehospital emergency services for the elderly falls 2017. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:164. [PMID: 30693301 PMCID: PMC6332656 DOI: 10.4103/jehp.jehp_86_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Falls are the most common cause of injuries in elderly population. This study aimed to determine the quality of prehospital emergency services (EMS) for the elderly falls in 2017. MATERIALS AND METHODS This cross-sectional study was carried out at the Pre-hospital Emergency Center of Kashan in 2017. The sample consisted of elderly people who had reported fall incidents in EMS. The questionnaire consisted of 7 areas with 54 items. Data collected by descriptive and inferential statistics of Friedman and Mann-Whitney were analyzed by SPSS v. 16 software. RESULTS The number of elderly people was 150 (58% female) and the average age was 68.22 ± 6.75 years. Most falls (88.65%) occurred at home. The average performance scores (between 0 and 2) were as follows: assessment of the scene of the incident (1.51), primary assessment of the elderly (1.46), airway management (1.64), circulation management (1.78), fixation (1.82), secondary and continuous assessment (1.59), and patient transfer (1.68). It was found that secondary assessment and transfer of the male patients were significantly higher in quality than female patients (P < 0.05). CONCLUSIONS In this research, the quality of care in all areas was reported to be desirable. It is recommended that the weaknesses of each area are investigated and the necessary strategies are taken into account such as staff training, changes in data collection forms, and training for the elderly.
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Affiliation(s)
| | - Negin Masoudi Alavi
- Medical Surgical Nursing Department, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Devriendt E, Heeren P, Fieuws S, Wellens NIH, Deschodt M, Flamaing J, Sabbe M, Milisen K. Unplanned Readmission prevention by Geriatric Emergency Network for Transitional care (URGENT): protocol of a prospective single centre quasi-experimental study. BMC Geriatr 2018; 18:244. [PMID: 30326860 PMCID: PMC6191899 DOI: 10.1186/s12877-018-0933-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND International guidelines recommend adapting the classic emergency department (ED) management model to the needs of older adults in order to ameliorate post-ED outcomes among this vulnerable group. To improve the care for older ED patients and especially prevent unplanned ED readmissions, the URGENT care model was developed. METHODS The URGENT care model is a nurse-led, comprehensive geriatric assessment based care model in the ED with geriatric follow-up after ED discharge. A prospective single centre quasi-experimental study (sequential design with two cohorts) is used to evaluate its effectiveness on unplanned ED readmission compared to usual ED care. Secondary outcome measures are hospitalization rate, ED length of stay, in-hospital length of stay, higher level of care, functional decline and mortality. DISCUSSION URGENT builds on previous research with adaptations tailored to the local context and addresses the needs of older patients in the ED with a special focus on transition of care. Although the selected approaches have been tested in other settings, evidence on this type of innovative care models in the ED setting is inconclusive. TRIAL REGISTRATION The study protocol is registered retrospectively with ISRCTN ( ISRCTN91449949 ).
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Affiliation(s)
- Els Devriendt
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Research Foundation Flanders, Egmontstraat 5, 1000 Brussels, Belgium
| | - Steffen Fieuws
- I-Biostat Interuniversity Institute for Biostatistics and statistical Bioinformatics KU Leuven, Kapucijnenvoer 35/3, 3000 Leuven, Belgium
| | - Nathalie I. H. Wellens
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Public Health and Social Affairs Department, Government Canton Vaud, Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Mieke Deschodt
- Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Marc Sabbe
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Public Health and Primary Care, Emergency Medicine, KU Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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Vilches-Moraga A, Fox J, Paracha A, Gomez-Quintanilla A, Epstein J, Pearce L. Predicting in-hospital mortality in older general surgical patients. Ann R Coll Surg Engl 2018; 100:529-533. [PMID: 29909664 DOI: 10.1308/rcsann.2018.0086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment. Methods This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service. Results A total of 577 patients were included with a mean age of 82.9 years. There was a female predominance (56%). The majority were living at home alone or with carers (93%) and most were independent in basic activities of daily living (79%). Over two-thirds (69%) were mobile with no walking aids or use of a walking stick and overt here-quarters (79%) had no cognitive impairment. Seventy-seven per cent of patients were managed non-operatively. The in-hospital mortality rate was 6.9%. Female sex (p=0.031), dependence in activities of daily living (p<0.001), cognitive impairment (p<0.001) and incontinence (p<0.001) were predictors of in-hospital mortality. ASA (American Society of Anesthesiologists) grade ≥3 was also associated with increased in-hospital mortality (odds ratio: 5.3, 95% confidence interval: 2.6-10.7). Conclusions Older general surgical patients present a high level of complexity. This study highlights the predictive role of mobility, functional and cognitive impairment when assessing this population. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on co-morbidities.
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Affiliation(s)
| | - J Fox
- Salford Royal NHS Foundation Trust , UK
| | - A Paracha
- Salford Royal NHS Foundation Trust , UK
| | | | - J Epstein
- Salford Royal NHS Foundation Trust , UK
| | - L Pearce
- Salford Royal NHS Foundation Trust , UK
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Preston L, Chambers D, Campbell F, Cantrell A, Turner J, Goyder E. What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06160] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BackgroundEmergency departments (EDs) are facing unprecedented levels of demand. One of the causes of this increased demand is the ageing population. Older people represent a particular challenge to the ED as those older people who are frail will require management that considers their frailty alongside their presenting complaint. How to identify these older people as frail and how best to manage them in the ED is a major challenge for the health service to address.ObjectivesTo systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on patient and health service outcomes.DesignA systematic mapping review.SettingEvidence from developed countries on interventions delivered in the ED.ParticipantsFrail and high-risk older people and general populations of older people (aged > 65 years).InterventionsInterventions to identify older people who are frail or who are at high risk of adverse outcomes and to manage (frail) older people within the ED.Main outcome measuresPatient outcomes (direct and indirect) and health service outcomes.Data sourcesEvidence from 103 peer-reviewed articles and conference abstracts and 17 systematic reviews published from 2005 to 2016.Review methodsA review protocol was drawn up and a systematic database search was undertaken for the years 2005–2016 (using MEDLINE, EMBASE, The Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium and PROSPERO). Studies were included according to predefined criteria. Following data extraction, evidence was classified into interventions relating to the identification of frail/high-risk older people in the ED and interventions relating to their management. A narrative synthesis of interventions/outcomes relating to these categories was undertaken. A quality assessment of individual studies was not undertaken; instead, an assessment of the overall evidence base in this area was made.ResultsOf the 90 included studies, 32 focused on a frail/high-risk population and 60 focused on an older population. These studies reported on interventions to identify (n = 57) and manage (n = 53) older people. The interventions to identify frail and at-risk older people, on admission and at discharge, utilised a number of different tools. There was extensive evidence on these question-based tools, but the evidence was inconclusive and contradictory. Service delivery innovations comprised changes to staffing, infrastructure and care delivery. There was a general trend towards improved outcomes in admissions avoidance, reduced ED reattendance and improved discharge outcomes.LimitationsThis review was a systematic mapping review. Some of the methods adopted differed from those used in a standard systematic review. Mapping the evidence base has led to the inclusion of a wide variety of evidence (in terms of study type and reporting quality). No recommendations on the effectiveness of specific interventions have been made as this was outside the scope of the review.ConclusionsA substantial body of evidence on interventions for frail and high-risk older people was identified and mapped.Future workFuture work in this area needs to determine why interventions work and whether or not they are feasible for the NHS and acceptable to patients.Study registrationThis study is registered as PROSPERO CRD42016043260.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Namboodri BL, Rosen T, Dayaa JA, Bischof JJ, Ramadan N, Patel MD, Grover J, Brice JH, Platts-Mills TF. Elder Abuse Identification in the Prehospital Setting: An Examination of State Emergency Medical Services Protocols. J Am Geriatr Soc 2018; 66:962-968. [PMID: 29566428 DOI: 10.1111/jgs.15329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe statewide emergency medical service (EMS) protocols relating to identification, management, and reporting of elder abuse in the prehospital setting. DESIGN Cross-sectional analysis. SETTING Statewide EMS protocols in the United States. PARTICIPANTS Publicly available statewide EMS protocols identified from published literature, http://EMSprotocols.org, and each state's public health website. MEASUREMENTS Protocols were reviewed to determine whether elder abuse was mentioned, elder abuse was defined, potential indicators of elder abuse were listed, management of older adults experiencing abuse was described, and instructions regarding reporting were provided. EMS protocols for child abuse were reviewed in the same manner for the purpose of comparison. RESULTS Of the 35 publicly available statewide EMS protocols, only 14 (40.0%) mention elder abuse. Of protocols that mention elder abuse, 6 (42.9%) define elder abuse, 10 (71.4%) describe indicators of elder abuse, 8 (57.1%) provide instruction regarding management, and 12 (85.7%) provide instruction regarding reporting. Almost twice as many states met each of these metrics for child abuse. CONCLUSION Statewide EMS protocols for elder abuse vary in regard to identification, management, and reporting, with the majority of states having no content on this subject. Expansion and standardization of protocols may increase the identification of elder abuse.
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Affiliation(s)
- Brooke L Namboodri
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tony Rosen
- Division of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Joseph A Dayaa
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason J Bischof
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nadeem Ramadan
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph Grover
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jane H Brice
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Jørgensen R, Brabrand M. Screening of the frail patient in the emergency department: A systematic review. Eur J Intern Med 2017; 45:71-73. [PMID: 28986161 DOI: 10.1016/j.ejim.2017.09.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department. AIM To assess the accuracy of the screening tools used in the emergency department to detect frailty in patients≥65years by their ability to identify the risk of adverse outcomes. METHODS An extensive medical literature search of Embase and PubMed was conducted, to identify studies using frailty screening scales in the emergency department. Data was subsequently extracted and evaluated from the results of the included studies. RESULTS Four studies met the exact inclusion criteria. Four different frailty screening scales: Clinical Frailty Scale, Deficit Accumulation Index, Identification of Seniors At Risk and The Study of Osteoporotic Fracture frailty index used in the emergency department were described and compared. Predictive values for various outcomes are represented and discussed. CONCLUSIONS The results suggest that frailty successfully predicts increased risk of hospitalization, nursing home admission, mortality and prolonged length of stay after an initial emergency department visit. Frailty does however not predict increased risk of 30day emergency department revisit. Further research highlighting the value of screening for frailty level in elderly emergency department patients is needed. LEARNING POINTS Although frail elders in need of further geriatric assessment should be identified as soon as possible, this systematic review only identified four cohort studies of frailty assessment in emergency departments. Although frailty screening appeared to predict the risk of mortality and of admission to hospital/nursing home, these four studies did not show that it could predict return visits to emergency departments within 30days. Randomized clinical trials of frailty screening tools compared to usual care or other methods of assessment are clearly needed.
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Affiliation(s)
- Rasmus Jørgensen
- Department of Orthopaedic Surgery, Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
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Carpenter CR, Melady D, Krausz C, Wagner J, Froelke B, Cordia J, Lowery D, Ruoff BE, Byrne LE, Miller DK, Lewis L. Improving Emergency Department Care for Aging Missourians: Guidelines, Accreditation, and Collaboration. MISSOURI MEDICINE 2017; 114:447-452. [PMID: 30228663 PMCID: PMC6139980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aging baby-boomers present significant challenges to accessible, affordable emergency care in America for patients of all ages. St. Louis physicians served as early innovators in the field of geriatric emergency medicine. This manuscript summarizes a multi-institutional November 2016 symposium reviewing the Missouri history of geriatric emergency care. In addition, this manuscript describes multispecialty organizations' guidelines, healthcare outcomes research, contemporary medical education paradigms, and evolving efforts to disseminate guideline-based geriatric emergency care using a "Boot Camp" approach and implementation science. This manuscript also reviews local adaptations to emergency medical services and palliative care, as well as the perspectives of emergency department leaders exploring the balance between infrastructure and personnel required to promote guideline-based geriatric emergency care with the anticipated benefits. This discussion is framed within the context of the American College of Emergency Physician's planned geriatric emergency department accreditation process scheduled to begin in 2018.
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Affiliation(s)
- Christopher R Carpenter
- Christopher R. Carpenter, MD, MSc, MSMA member since 2016, is Associate Professor, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Don Melady
- Don Melady, MD, Msc(Ed) is Assistant Professor, Department of Emergency Medicine, University of Toronto
| | - Craig Krausz
- Craig Krausz, MD, is Associate Professor of Surgery, Saint Louis University School of Medicine
| | - Jason Wagner
- Jason Wagner, MD, is Assistant Professor, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Brian Froelke
- Brian Froelke, MD, is Assistant Professor, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jennifer Cordia
- Jennifer Cordia, RN, BSN, MBA, is Chief Nursing Officer, is at Christian Northeast Hospital, St. Louis, MO
| | - Derrick Lowery
- Derrick Lowery, MD, Director, Palliative Care Services, is at Christian Northeast Hospital, St. Louis, MO
| | - Brent E Ruoff
- Brent E. Ruoff, MD, MSMA member since 2003, is Associate Professor, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Laurie E Byrne
- Laurie E. Byrne, MD, is Emergency Medicine Division Chief, Saint Louis University School of Medicine
| | - Douglas K Miller
- Douglas K. Miller, MD, is in the Division of Geriatric Medicine, Department of Internal Medicine, Saint University School of Medicine and Indiana University Center for Aging Research Regenstrief Institute Indianapolis, IN
| | - Lawrence Lewis
- Lawrence Lewis, MD, is Professor, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
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Revised National Estimates of Emergency Department Visits for Sepsis in the United States. Crit Care Med 2017; 45:1443-1449. [PMID: 28817480 DOI: 10.1097/ccm.0000000000002538] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING U.S. emergency department visits, 2009-2011. PATIENTS Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). CONCLUSIONS Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated sepsis classifications may impact national estimates of emergency department sepsis epidemiology.
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Duong HV, Herrera LN, Moore JX, Donnelly J, Jacobson KE, Carlson JN, Mann NC, Wang HE. National Characteristics of Emergency Medical Services Responses for Older Adults in the United States. PREHOSP EMERG CARE 2017; 22:7-14. [PMID: 28862480 DOI: 10.1080/10903127.2017.1347223] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. METHODS We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, non-emergency medical transports, and standby responses. We defined older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. RESULTS During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71-1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96-1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96-3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00-2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. CONCLUSION One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.
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Solé-Casals M, Chirveches-Pérez E, Puigoriol-Juvanteny E, Nubó-Puntí N, Chabrera-Sanz C, Subirana-Casacuberta M. Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department. ENFERMERIA CLINICA 2017; 28:365-374. [PMID: 28583833 DOI: 10.1016/j.enfcli.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. MATERIAL AND METHODS Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. RESULTS 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). CONCLUSIONS Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy.
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Affiliation(s)
- Montserrat Solé-Casals
- Dirección de Enfermería, Centre Integral de Salut Cotxeres, Barcelona, España; Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España.
| | - Emilia Chirveches-Pérez
- Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España; Unidad de Epidemiología Clínica, Hospital Universitari Vic, Vic, Barcelona, España
| | | | - Núria Nubó-Puntí
- Gestión de Continuidad de Cuidados, Hospital Universitari de Vic, Vic, Barcelona, España
| | - Carolina Chabrera-Sanz
- Escola Superior de Ciències de la Salut Tecnocampus, Universitat Pompeu Fabra, Mataró, Barcelona, España
| | - Mireia Subirana-Casacuberta
- Grupo de Investigación en "Methodology, Methods, Models and Health and Social Outcomes" (M3O), Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, España; Dirección de Cuidados, Hospital Universitari de Vic, Vic, Barcelona, España
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Harris M, Fry M. The utilisation of one district hospital emergency department by people with Parkinson's disease. ACTA ACUST UNITED AC 2017; 20:1-5. [PMID: 28073650 DOI: 10.1016/j.aenj.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/08/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder in Australia and the economic burden is more than $8.3 billion a year and predicted to escalate. However, little is known of the trends and characteristics of people with Parkinson's disease presenting to emergency departments (ED). METHOD The study design was a 12 month retrospective medical record audit. The study was conducted in one metropolitan 300 bed district hospital in an outer suburb of Sydney. RESULTS One hundred and twenty nine adult patients (0.4%) with PD presented with a mean age of 79.5 years (SD 7.7); all were over 60 years of age. Of the 129 PD patient cases, there were 260 separate ED episodes of care with the majority (n=151; 58.1%) of patients living in the community and presenting with falls (n=108; 41.5%). There was no statistical difference in triage code allocation when comparing PD patients and ED adult patients (over 60years). There was no difference in representation rate when comparing those over 80years (n=128) with those under 80 years (n=132). The average length of stay for PD patient episodes was 323min (SD 225) compared with 193min (SD 136) for ED patients. Younger adult patient episodes (n=132; 51.0%) were admitted to hospital more frequently than those aged over 80 years (Pearson's X2 test 162.2; df 1; p<0.001. CONCLUSION We identified in this study that people with PD have a high rate of falls, longer length of stay, high admission rate and represent frequently to the ED. Improved detection, management and a multidisciplinary approach for people with PD along with strict medication regime adherence is likely to improve safety, quality of life, reduce symptom aggravation and ongoing risk of falls.
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Affiliation(s)
| | - Margaret Fry
- Northern Sydney Local Health District, Faculty of Health, University of Technology Sydney, Australia.
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Abstract
Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; P<0.001). Survival rates differed significantly between patients by dementia status (P<0.001). Mean Medicare payments for ED services were significantly higher among patients with dementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.
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Bo M, Bonetto M, Bottignole G, Porrino P, Coppo E, Tibaldi M, Ceci G, Raspo S, Cappa G, Bellelli G. Postdischarge Clinical Outcomes in Older Medical Patients with an Emergency Department Stay-Associated Delirium Onset. J Am Geriatr Soc 2016; 64:e18-9. [DOI: 10.1111/jgs.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mario Bo
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Martina Bonetto
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle di Cuneo; Cuneo Italy
| | - Giuliana Bottignole
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Paola Porrino
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Eleonora Coppo
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Michela Tibaldi
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Giacomo Ceci
- Struttura Complessa a Direzione Universitaria Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Silvio Raspo
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle di Cuneo; Cuneo Italy
| | - Giorgetta Cappa
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle di Cuneo; Cuneo Italy
| | - Giuseppe Bellelli
- Dipartimento di Scienze della Salute; Università Milano-Bicocca; Milan Italy
- Acute Geriatric Unit; San Gerardo Hospital; Monza Italy
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Abrashkin KA, Washko J, Zhang J, Poku A, Kim H, Smith KL. Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program-Preliminary Data. J Am Geriatr Soc 2016; 64:2572-2576. [DOI: 10.1111/jgs.14484] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen A. Abrashkin
- Department of Internal Medicine; Hoftstra-Northwell School of Medicine; New Hyde Park New York
| | - Jonathan Washko
- Center for Emergency Medical Services; Northwell Health; New Hyde Park New York
| | - Jenny Zhang
- Department of Internal Medicine; Hoftstra-Northwell School of Medicine; New Hyde Park New York
| | - Asantewaa Poku
- Department of Internal Medicine; Hoftstra-Northwell School of Medicine; New Hyde Park New York
| | - Hyun Kim
- Division of Environmental Health Sciences; University of Minnesota; Minneapolis Minnesota
| | - Kristofer L. Smith
- Department of Internal Medicine; Hoftstra-Northwell School of Medicine; New Hyde Park New York
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LaMantia MA, Messina FC, Jhanji S, Nazir A, Maina M, McGuire S, Hobgood CD, Miller DK. Emergency medical service, nursing, and physician providers' perspectives on delirium identification and management. DEMENTIA 2016; 16:329-343. [PMID: 26112165 DOI: 10.1177/1471301215591896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of the study The study objective was to understand providers' perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient's home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients' baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Frank C Messina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shola Jhanji
- Indiana University-Purdue University, Indianapolis, IN, USA
| | - Arif Nazir
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mungai Maina
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
| | - Siobhan McGuire
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
| | | | - Douglas K Miller
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indianapolis, IN
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Bo M, Bonetto M, Bottignole G, Porrino P, Coppo E, Tibaldi M, Ceci G, Raspo S, Cappa G, Bellelli G. Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients. J Am Geriatr Soc 2016; 64:1114-9. [DOI: 10.1111/jgs.14103] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mario Bo
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Martina Bonetto
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle; Cuneo Italy
| | - Giuliana Bottignole
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Paola Porrino
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Eleonora Coppo
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Michela Tibaldi
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Giacomo Ceci
- Struttura Complessa Dipartimento Universitario Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette; Torino Italy
| | - Silvio Raspo
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle; Cuneo Italy
| | - Giorgetta Cappa
- Struttura Complessa Geriatria e Cure Intermedie; Azienda Sanitaria Ospedaliera Santa Croce e Carle; Cuneo Italy
| | - Giuseppe Bellelli
- Acute Geriatric Unit; Dipartimento di Scienze della Salute; Università Milano-Bicocca; Milan and S. Gerardo Hospital; Monza Italy
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da Silva HC, Pessoa RDL, de Menezes RMP. Trauma in elderly people: access to the health system through pre-hospital care. Rev Lat Am Enfermagem 2016; 24:e2690. [PMID: 27143543 PMCID: PMC4863419 DOI: 10.1590/1518-8345.0959.2690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to identify the prevalence of trauma in elderly people and how they accessed the
health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a
sample of 400 elderly trauma victims selected through systematic random sampling.
A form validated by experts was used to collect the data. Descriptive statistical
analysis was applied. The chi-square test was used to analyze the association
between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69
years (38.25%), average age 74.19 years (standard deviation±10.25). Among the
mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a
significant relation with the pre-hospital care services (p<0.001).
Circulation, airway opening, cervical control and immobilization actions were the
most frequent and Basic Life Support Services (87.8%) were the most used, with
trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care
through basic life support services and actions and were transported to the trauma
referral hospital. It is important to reorganize pre-hospital care, avoiding
overcrowded hospitals and delivering better care to elderly trauma victims.
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A national survey of Canadian emergency medicine residents' comfort with geriatric emergency medicine. CAN J EMERG MED 2016; 19:9-17. [PMID: 27086864 DOI: 10.1017/cem.2016.27] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Geriatric patients represent a large and complex subgroup seen in emergency departments (EDs). Competencies in geriatric emergency medicine (EM) training have been established. Our objectives were to examine Canadian postgraduate year (PGY)-5 EM residents' comfort with the geriatric EM competency domains, assess whether Canadian EM residents become more comfortable through residency, and determine whether geriatric educational exposures are correlated with resident comfort with geriatric EM. METHODS A national, cross-sectional study of PGY-1 and PGY-5 Royal College EM residents was conducted to determine their comfort in geriatric EM clinical competency domains. Residents reported their level of comfort in satisfying each competency domain using a seven-point Likert scale. Residents were also asked about the location of their medical education as well as the type and number of different geriatric exposures that they had received to date. RESULTS Of the 141 eligible residents from across Canada, 77% (109) consented to participate. None of the PGY-1 EM residents and 34% (14) of PGY-5 EM residents reported that they were comfortable with all eight geriatric EM competency domains. PGY-5 EM residents were significantly more comfortable than PGY-1 EM residents. Residents reported a highly variable range of geriatric educational exposures obtained during training. No relationship was found between resident-reported comfort and the nature or number of geriatric exposures that they had received. CONCLUSION Current Royal College EM residency training in Canada may not be adequately preparing graduates to be comfortable with defined competencies for the care of older ED patients.
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Zozula A, Carpenter CR, Lipsey K, Stark S. Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review. Emerg Med J 2016; 33:345-50. [DOI: 10.1136/emermed-2015-204815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 11/29/2015] [Indexed: 11/04/2022]
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