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Corcoran G, Bernard P, Kenna L, Malone A, Horgan F, O'Brien C, Ward P, Howard W, Hogan L, Mooney R, Masterson S. "Older People Want to Be in Their Own Homes": A Service Evaluation of Patient and Carer Feedback after Pathfinder Responded to Their Emergency Calls. PREHOSP EMERG CARE 2023; 27:866-874. [PMID: 36633524 DOI: 10.1080/10903127.2023.2168094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Older people experience high rates of adverse outcomes following emergency department (ED) presentation. There is growing evidence to support alternative care pathways for certain types of emergency medical services (EMS) calls. Pathfinder is one such service and targets patients aged 65 years and over, whose presenting issues can be safely managed at home by immediate paramedic, occupational therapy, and/or physiotherapy interventions. The aim of this service evaluation was to understand how older people feel about being treated at home as a result of EMS calls and to understand their experiences of the Pathfinder service. METHODS This was a thematic analysis of open-ended responses recorded from telephone interviews during routine service evaluation with service users (patients or their next-of-kin). RESULTS Of 573 service users, telephone interviews were conducted with 429 (75%). Five primary themes were identified: (1) professionalism of the multidisciplinary clinical team; (2) "the right service, in the right place, at the right time"; (3) role of Pathfinder in "getting the ball rolling"; (4) lasting effects of the experience on the patient and his or her next-of-kin; (5) value of skilled communication with the older person. CONCLUSION Older people and their next-of-kin voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be treated in their homes at the time of an EMS call rather than default conveyance to the ED. They appreciated the importance of a skilled multidisciplinary team with a follow-up service that effectively positions itself between the acute hospital and community services.
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Affiliation(s)
- Grace Corcoran
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Paul Bernard
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Lawrence Kenna
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Ailish Malone
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire O'Brien
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Peter Ward
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Willie Howard
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Laura Hogan
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Rebecca Mooney
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Bernard P, Corcoran G, Kenna L, O’Brien C, Ward P, Howard W, Hogan L, Mooney R, Masterson S. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50:1854-1858. [PMID: 34107008 DOI: 10.1093/ageing/afab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND many patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. Alternative care pathway models can reduce ED crowding and improve outcomes. Internationally, there is no consensus on which model is recommended. AIM the aim of this study is to investigate the impact of the Pathfinder model on ED conveyance rates and patient safety. METHODS the Pathfinder service is a collaboration between the National Ambulance Service and Beaumont Hospital Occupational Therapy and Physiotherapy Departments. It is supported by the Government of Ireland's Sláintecare Integration fund. This is a retrospective cohort study of the Pathfinder service over a 5-month period. RESULTS one-hundred and seventy-eight patients were responded to by the Pathfinder 'Rapid Response Team'. Average age was 79.6 years (standard deviation 7.6), median clinical frailty score was 6 (interquartile range: 5-6). Sixty-four percent remained at home following initial review. None re-presented to the ED within 24 hours, and 10% re-presented within 7 days. The majority (67%) of patients required follow-up by the Pathfinder 'Follow-Up Team' and/or another community-based service. Feedback demonstrates 99% patient satisfaction with the service. CONCLUSION the Pathfinder service is a safe alternative to ED conveyance for older people following an EMS call. It is the first model of this kind to be evaluated in Ireland. The overwhelmingly positive feedback confirms that older people want this service. This model could expand, with local adaptation, nationally and internationally.
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Affiliation(s)
- Paul Bernard
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Grace Corcoran
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Lawrence Kenna
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Claire O’Brien
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Peter Ward
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - William Howard
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Laura Hogan
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Rebecca Mooney
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Jacobsson A, Kurland L, Höglund E. Direct in-hospital admission via ambulance (DIVA): A retrospective observational study. Int Emerg Nurs 2020; 52:100906. [PMID: 32827937 DOI: 10.1016/j.ienj.2020.100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prolonged stays in emergency departments increase the risk of adverse events in elderly patients. To optimize care for nonurgent patients who need in-hospital admission, a patient-focused improvement project named Direct In-hospital admission Via Ambulance (DIVA) was launched at Örebro University Hospital. PURPOSE This study describes the effects of DIVA. The primary outcome was time to in-hospital admission. Secondary outcomes were the in-hospital admission rate, the in-hospital length of stay and patient characteristics. METHOD This was a retrospective observational study. Descriptive and comparative statistics were used. All patients identified by the ambulance nurse as nonurgent but with an apparent need for in-hospital admission were candidates for direct in-hospital admission. The results were compared with those of a reference group. RESULT In total, 127 patients were included, with 45 patients in the DIVA group and 82 patients in the reference group. In the DIVA group, 24 patients were directly admitted. The median time to in-hospital admisson was 49.5 min for direct admitted patients and 278.5 min for the reference group. There was a statistical significant difference between the groups (p < 0.01). CONCLUSION The current study indicates that time to in-hospital admission could be reduced by DIVA.
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Affiliation(s)
- Andreas Jacobsson
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden.
| | - Lisa Kurland
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
| | - Erik Höglund
- Department of Emergency Care, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
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ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults. J Emerg Nurs 2017; 43:57-69. [PMID: 28131350 DOI: 10.1016/j.jen.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 01/29/2023]
Abstract
The rise in ED utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to have a positive impact on the care of older adults. Symptoms have been associated with ED utilization; however, it remains unclear whether symptoms are the primary reason for ED utilization. The purpose of this study was to describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department and to examine the differences in self-reported symptoms among those who did and did not utilize the emergency department. METHODS A prospective longitudinal design was used. The sample included 403 community-dwelling older adults aged 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. RESULTS Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance and fair/poor well-being were significantly associated with ED utilization. DISCUSSION Several symptoms were common among this cohort of older adults. However, no significant differences were found in the types of symptoms reported by older adults who utilized the emergency department compared with those who did not utilize the emergency department. Based on these findings, it appears that symptoms among community-dwelling older adults may not be the primary reason for ED utilization.
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Deasey D, Kable A, Jeong S. Emergency nurses attitudes towards older people in the emergency department: a cross-sectional study. Contemp Nurse 2016; 52:369-80. [PMID: 27579627 DOI: 10.1080/10376178.2016.1224122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To report nurses' attitudes towards older people in the emergency department (ED). BACKGROUND A nurse's attitude towards an older person can have an effect on nurses' work practices and interactions and can result in adverse outcomes for the older person. DESIGN A national cross-sectional survey using a previously validated instrument Older Person in Acute Care Survey (OPACS) was conducted to measure emergency nurses' attitudes towards older people in their care. METHODS Members of the College of Emergency Nursing Australasia (CENA) were invited to participate in the study. There were 371 (39%) completed surveys returned. RESULTS The OPACS survey identified that ED nurses have positive attitudes towards older people in the ED. CONCLUSION The implications for practice are clinically significant because positive attitudes can result in prevention of discrimination and marginalisation of the older person in the ED.
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Affiliation(s)
- Debra Deasey
- a School of Nursing and Midwifery , University of Newcastle , University Drive, Callaghan , NSW 2308 , Australia
| | - Ashley Kable
- a School of Nursing and Midwifery , University of Newcastle , University Drive, Callaghan , NSW 2308 , Australia
| | - Sarah Jeong
- a School of Nursing and Midwifery , University of Newcastle , University Drive, Callaghan , NSW 2308 , Australia
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Hamilton C, Ronda L, Hwang U, Abraham G, Baumlin K, Morano B, Nassisi D, Richardson L. The Evolving Role of Geriatric Emergency Department Social Work in the Era of Health Care Reform. SOCIAL WORK IN HEALTH CARE 2015; 54:849-868. [PMID: 26565950 DOI: 10.1080/00981389.2015.1087447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the era of Medicaid Redesign and the Affordable Care Act, the emergency department (ED) presents major opportunities for social workers to assume a leading role in the delivery of care. Through GEDI WISE-Geriatric Emergency Department Innovations in care through Workforce, Informatics and Structural Enhancements,-a unique multidisciplinary partnership made possible by an award from the Center for Medicare and Medicaid Innovation, social workers in The Mount Sinai ED have successfully contributed to improvements in health outcomes and transitions for older adults receiving emergency care. This article will describe the pivotal and highly valued role of the ED social worker in contributing to the multidisciplinary accomplishments of GEDI WISE objectives in this new model of care.
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Affiliation(s)
- Christine Hamilton
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Liza Ronda
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Ula Hwang
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Gallane Abraham
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Kevin Baumlin
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Barbara Morano
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Denise Nassisi
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
| | - Lynne Richardson
- a Department of Social Work Services , The Mount Sinai Hospital , New York , New York , USA
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O’Connell B, Hawkins M, Considine J, Au C. Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp. Contemp Nurse 2014; 45:228-33. [DOI: 10.5172/conu.2013.45.2.228] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yu SJ, Gang IS. A Comparative Study on the Process of Hospital Visits according to the Characteristics of the Elderly Visiting to Emergency Medical Centers. ACTA ACUST UNITED AC 2014. [DOI: 10.12811/kshsm.2014.8.1.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hoon LS, Mackey S, Hong-Gu H. Elderly patients' experiences of care received in the emergency department: a systematic review. ACTA ACUST UNITED AC 2012; 10:1363-1409. [PMID: 27820308 DOI: 10.11124/01938924-201210230-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Elderly patients admitted into the emergency department present with high levels of illness acuity and severity, accompanied by multiple and complex medical and psychosocial issues, creating challenges for health care professionals to provide appropriate care. OBJECTIVE To determine the best available evidence on elderly patients' experiences of care received in the emergency department. INCLUSION CRITERIA The review considered studies that included male and female patients of all ethnic groups who were 65 years old and above, and admitted to the emergency department with urgent and non-urgent health-related issues. Both quantitative and qualitative studies were included. The phenomena of interest were the experiences of elderly patients in the emergency department. SEARCH STRATEGY A three-step search strategy was utilised in this review. The following databases were searched for articles published in English before year 2010: CINAHL, Medline, Scopus, PsycINFO, Mednar and Cochrane library. METHODOLOGICAL QUALITY Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal checklists from the Joanna Briggs Institute. DATA COLLECTION Data were extracted using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (MAStARI) for descriptive/case series, and Qualitative Assessment and Review Instrument (QARI) for interpretive and critical research. DATA SYNTHESIS The findings from the quantitative study were presented in a narrative summary. The findings from the qualitative papers were pooled using JBI-QARI, involving the aggregation of findings to generate a set of statements that represent that aggregation. RESULTS A total of five papers were included in this review. The quantitative evidence demonstrated elderly patients' satisfaction level with care received in the emergency department was related to the length of waiting time and the information and pain management received. Two syntheses were generated from 12 unequivocal or credible findings from the qualitative evidence: 1) Health care professionals should be aware of the intolerable factors of the waiting experiences and appreciate the positive attitudes of elderly patients at the emergency department in order to improve the care provided; 2) There is a need for improvement for nursing staff to deliver the appropriate attention needed by elderly patients and meet their expectations to deliver professional and competent nursing care. CONCLUSIONS This review found that elderly patients had negative experiences, which mainly occurred during the waiting period and were related to long waiting time and physical environment. They were generally satisfied with the care they received from nurses. However, they expressed the need for more physiological, psychological and information support IMPLICATIONS FOR PRACTICE: Waiting time should be shortened for elderly patients. Patients' physiological and psychological needs should be paid more attention. The physical environment and facility design of the emergency department should be made more patient friendly. Complete information and clear answers to questions should be provided. IMPLICATIONS FOR RESEARCH Future studies are needed to better understand elderly patients' needs and their experiences of care at the emergency department; to develop strategies that may improve elderly patients' experiences; to compare the experiences and satisfaction levels of those who have shorter versus longer periods of waiting time; and to explore health care professionals' perception of the care provided to elderly patients in the emergency department.
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Affiliation(s)
- Lim Siew Hoon
- 1. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore National University Hospital Centre for Evidence Based Nursing: A collaborating centre of the Joanna Briggs Institute
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Hoon LS, Mackey S, Hong-Gu H. Elderly patientsʼ experiences of care received in the emergency department: a systematic review. ACTA ACUST UNITED AC 2012. [DOI: 10.11124/jbisrir-2012-52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Parke B, Beaith A, Slater L, Clarke AM. Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review. J Adv Nurs 2011; 67:1426-48. [PMID: 21382076 DOI: 10.1111/j.1365-2648.2011.05611.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM This paper is a report of a scoping review of research on cognitive impairment in older adults who visit Emergency Departments of acute care hospitals, followed by an integrative review that included a quality assessment to determine the effectiveness of interventions for this population. BACKGROUND Being old and cognitively impaired in the Emergency Department--a fast-paced intervention system--is a complex phenomenon that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large impact on healthcare systems. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium or dementia in non-institutionalized older people (65+ years) in the Emergency Department. REVIEW METHODS Titles screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers completed independent data extraction and synthesis of included studies. Quality assessment occurred using the Critical Appraisal Skills Programme Tools. RESULTS Fifteen studies met the inclusion criteria for integrative review. Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are needed. Contextual details and relevant features of an appropriate intervention are poorly explained. CONCLUSION Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and programmatic responses remain elusive. Quality improvements require more thorough examination of emergency department context to identify modifiable influencing factors that are transferable across settings.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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Hoon LS, Mackey S, Hong-Gu H. Elderly patients' experiences of care in the emergency department: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2010; 8:1-25. [PMID: 27820353 DOI: 10.11124/01938924-201008341-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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