Skip to main content Accessibility help
×
Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T03:58:48.701Z Has data issue: false hasContentIssue false

Chapter 6 - Processes: Implementing Protocols and Policies

Published online by Cambridge University Press:  20 January 2022

John Schumacher
Affiliation:
University of Maryland, Baltimore County
Don Melady
Affiliation:
University of Toronto
Get access

Summary

Defines protocol, policy, and process and their importance in creating the Geriatric ED. Presents nearly 30 different processes that you can adopt or adapt to move towards geriatric-focussed ED care. Screening; enhanced assessments; workflow changes; transitions of care; physical comfort. Encourages EDs to consider which are going to be both easiest to implement and which are going be highest impact.

Type
Chapter
Information
Creating a Geriatric Emergency Department
A Practical Guide
, pp. 63 - 87
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Donabedian, A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743–8.CrossRefGoogle ScholarPubMed
Gleason, LJ, Escue, ED, Hogan, TM. Older adult emergency department pain management strategies. Clin Geriatr Med. 2018/06/13ed. 8;34(3):491504.Google Scholar
Warden, V, Hurley, AC, Volicer, L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003 Jan 1;4(1):915.CrossRefGoogle ScholarPubMed
Ellis, B, Melady, D, Foster, N, et al. Using volunteers to improve the experience of older patients in the emergency department. CJEM. 2020 Jul;22(4):514–18.CrossRefGoogle ScholarPubMed
Sanon, M, Baumlin, KM, Kaplan, SS, Grudzen, CR. Care and respect for elders in emergencies program: a preliminary report of a volunteer approach to enhance care in the emergency department. J Am Geriatr Soc. 2014 Feb 1;62(2):365–70.CrossRefGoogle Scholar
Heeren, P, Devriendt, E, Wellens, NIH, et al. Old and new geriatric screening tools in a Belgian emergency department: a diagnostic accuracy study. J Am Geriatr Soc. 2020/05/13ed. 2020 Jul;68(7):1454–61.CrossRefGoogle Scholar
Inouye, SK, van Dyck, CH, Alessi, CA, Balkin, S, Siegal, AP, Horwitz, RI. Clarifying confusion: the confusion assessment method. Ann Intern Med. 1990 Dec 15;113(12):941–8.Google Scholar
Han, JH, Eden, S, Shintani, A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18(5):451–7.CrossRefGoogle ScholarPubMed
Tieges, Z, Maclullich, AMJ, Anand, A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing [Internet]. 2020 Nov 11 [cited 2021 Mar 2];(afaa224). Available from: https://doi.org/10.1093/ageing/afaa224CrossRefGoogle Scholar
Carpenter, C, Bassett, E, Fischer, G, Shirshekan, J, Galvin, J, Morris, J. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer’s screen, short blessed test, Ottawa 3DY, and the caregiver-completed AD8. Acad Emerg Med. 2011;18(4):374–84.CrossRefGoogle ScholarPubMed
Eagles, D, Otal, D, Wilding, L, et al. Evaluation of the Ottawa 3DY as a screening tool for cognitive impairment in older emergency department patients. Am J Emerg Med. 2020 Dec 1;38(12):2545–51.CrossRefGoogle ScholarPubMed
O’Sullivan, D, Brady, N, Manning, E, et al. Validation of the 6-item cognitive impairment test and the 4AT test for combined delirium and dementia screening in older emergency department attendees. Age Ageing. 2018 Jan 1;47(1):61–8.Google Scholar
Carpenter, CR, Malone, ML. Avoiding therapeutic nihilism from complex geriatric intervention “negative” trials: STRIDE lessons. J Am Geriatr Soc [Internet]. 2020/10/20ed. 2020 Oct; Available from: www.ncbi.nlm.nih.gov/pubmed/33079398Google Scholar
Brousseau, AA, Dent, E, Hubbard, R, et al. Identification of older adults with frailty in the emergency department using a frailty index: results from a multinational study. Age Ageing. 2018 Mar 1;47(2):242–8.CrossRefGoogle ScholarPubMed
Rockwood, K, Song, X, MacKnight, C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489–95.Google Scholar
Romero-Ortuno, R, Wallis, S, Biram, R, Keevil, V. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: an observational study. Eur J Intern Med. 2016/09/02ed. 2016 Nov;35:2434.CrossRefGoogle ScholarPubMed
Asomaning, N, Loftus, C. Identification of Seniors at Risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results. J Emerg Nurs. 2014 Jul 1;40(4):357–364.e1.Google Scholar
McCusker, J, Bellavance, F, Cardin, S, Trepanier, S, Verdon, J, Ardman, O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999 Oct 1;47(10):1229–37.CrossRefGoogle ScholarPubMed
Dendukuri, N, McCusker, J, Belzile, E. The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc. 2004;52(2):290–6.CrossRefGoogle ScholarPubMed
Galvin, R, Gilleit, Y, Wallace, E, et al. Adverse outcomes in older adults attending emergency departments: a systematic review and meta-analysis of the Identification of Seniors at Risk (ISAR) screening tool. Age Ageing. 2017;46(2):179–86.Google ScholarPubMed
de Gelder, J, Lucke, JA, Blomaard, LC, et al. Optimization of the APOP screener to predict functional decline or mortality in older emergency department patients: cross-validation in four prospective cohorts. Exp Gerontol. 2018/06/20ed. 9;110:253–9.CrossRefGoogle ScholarPubMed
Lee, JS, Schwindt, G, Langevin, M, et al. Validation of the Triage Risk Stratification Tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Geriatr Soc. 2008 Nov;56(11):2112–17.CrossRefGoogle ScholarPubMed
Fan, J, Worster, A, Fernandes, C. Predictive validity of the Triage Risk Screening Tool for elderly patients in a Canadian emergency department. Am J Emerg Med. 2006 Sep;24(5):540–4.Google Scholar
The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019 Apr 1;67(4):674–94.Google Scholar
Hill-Taylor, B, Walsh, KA, Stewart, S, Hayden, J, Byrne, S, Sketris, IS. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016 Apr 1;41(2):158–69.CrossRefGoogle Scholar
Stevens, JA, Phelan, EA. Development of STEADI: a fall prevention resource for health care providers. Health Promot Pract. 2012 Nov 16;14(5):706–14.Google Scholar
Chow, RB, Lee, A, Kane, BG, et al. Effectiveness of the “Timed Up and Go” (TUG) and the chair test as screening tools for geriatric fall risk assessment in the ED. Am J Emerg Med. 2018/06/07ed. 3;37(3):457–60.Google Scholar
Rosen, T, Stern, ME, Elman, A, Mulcare, MR. Identifying and initiating intervention for elder abuse and neglect in the emergency department. Clin Geriatr Med. 2018/06/15ed. 2018;34(3):435–51.CrossRefGoogle ScholarPubMed
Yaffe, MJ, Wolfson, C, Lithwick, M, Weiss, D. Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)©. J Elder Abuse Negl. 2008 Jun 12;20(3):276300.CrossRefGoogle ScholarPubMed
Liberman, T, Roofeh, R, Sohn, N, et al. The GAP-ED project: improving care for elderly patients presenting to the emergency department. J Emerg Med. 2019/12/03ed. 2020 Feb;58(2):191–7.CrossRefGoogle ScholarPubMed
Shaw, FE, Bond, J, Richardson, DA, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ. 2003 Jan 11;326(7380):73.CrossRefGoogle Scholar
Carpenter, CR, Cameron, A, Ganz, DA, Liu, S. Older adult falls in emergency medicine: a sentinel event. Clin Geriatr Med. 2018;34(3):355–67.CrossRefGoogle Scholar
Coleman, EA, Boult, C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003 Apr 1;51(4):556–7.Google ScholarPubMed
Parashar, R, McLeod, S, Melady, D. Discrepancy between information provided and information required by emergency physicians for long-term care patients. CJEM. 2017/07/17ed. 5;20(3):362–7.Google ScholarPubMed
Morse, L, Xiong, L, Ramirez-Zohfeld, V, Dresden, S, Lindquist, LA. Tele-follow-up of older adult patients from the Geriatric Emergency Department Innovation (GEDI) program. Geriatrics [Internet]. 2019/01/29ed. 2019 Jan;4(1). Available from: www.ncbi.nlm.nih.gov/pubmed/31023986CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×