Transitions of Care for the Geriatric Patient in the Emergency Department

2013 ◽  
Vol 29 (1) ◽  
pp. 49-69 ◽  
Author(s):  
Chad Kessler ◽  
Meredith C. Williams ◽  
John N. Moustoukas ◽  
Cleo Pappas
Keyword(s):  
Emergency Department ◽  
Geriatric Patient ◽  
Transitions Of Care

Abstract WP384: Redesigning the Information Highway - Using Video to Improve Nurse Satisfaction with Patients’ Transitions from the Emergency Department to the Neuroscience Unit

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Melissa Richardson ◽  
Omid Salehi ◽  
Kevin Hinkelman ◽  
Clarke Tyan ◽  
Teresa Young ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pilot Project ◽  
Transitions Of Care ◽  
Nurse Satisfaction ◽  
Nursing Satisfaction ◽  
Hand Off ◽  
Neurological Exam ◽  
Pertinent Information ◽  
Strongly Agree ◽  
The Sacrifice

Background: An effective hand-off process promotes transfer of critical information during transitions of care, thus decreasing the risk of adverse events. For patients with neurological symptoms, exchanging information over the phone may not provide the complete clinical picture of the patient and may contribute to the receiving nurse under appreciating early neurological changes. However, having the nurse leave a busy emergency department (ED) to perform bedside hand-off on the neuroscience unit (NSU) is often not realistic. Purpose: To improve nursing satisfaction with the hand-off process between the ED and the NSU, comparing video and phone report. Methods: The population consisted of stroke patients admitted from the ED to the NSU over a three month period. The intervention was offering a computer with video for the ED nurse to share pertinent information and perform a neurological exam, a process which allowed the receiving nurse to ask questions and interact with the patient. Nurses who used the video hand-off (n=24) were surveyed at the end of the pilot project to measure their satisfaction. Results: Overall, the nurses were more satisfied using video. (Figure). The increase in percentage of nurses answering “Strongly Agree”/ “Agree” were noted in these areas: 71%-85% for relevance of information, 68%-81% for efficiency, 54%-58% for staff relationships, 33%-63% for patient engagement, and 42%-75% for reducing risk for error. Conclusions: The use of video during transition of care provides an option for hospitals to employ an interactive handoff between departments without the sacrifice of time. Nursing should further explore the benefits of video technology during transitions of care, particularly inter-departmental transfers for special populations.

Tracking the Rise of Geriatric Emergency Departments in the United States

2018 ◽  
Vol 39 (8) ◽  
pp. 871-879 ◽  
Author(s):  
John G. Schumacher ◽  
Jon Mark Hirshon ◽  
Phillip Magidson ◽  
Marilyn Chrisman ◽  
Terisita Hogan
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Emergency Departments ◽  
The United States ◽  
Transitions Of Care ◽  
Emergency Department Care ◽  
Equipment And Supplies ◽  
Care Services ◽  
Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

107 Improving Transitions of Care for Patients Initiated on Buprenorphine from the Emergency Department

2020 ◽  
Vol 76 (4) ◽  
pp. S42
Author(s):  
C. Fockele ◽  
L. Whiteside ◽  
H. Duber ◽  
B. Finegood ◽  
S. Morse
Keyword(s):  
Emergency Department ◽  
Transitions Of Care

Low-Income Senior Housing Residents’ Emergency Department Use and Care Transition Problems

2017 ◽  
Vol 31 (6) ◽  
pp. 610-616 ◽  
Author(s):  
Antoinette B. Coe ◽  
Leticia R. Moczygemba ◽  
Kelechi C. Ogbonna ◽  
Pamela L. Parsons ◽  
Patricia W. Slattum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Personal Health Record ◽  
Primary Care Providers ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Care Providers ◽  
Senior Housing ◽  
Follow Up Care

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

scholarly journals Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

2011 ◽  
Vol 3 (1) ◽  
pp. 37-40 ◽  
Author(s):  
Dustin Smith ◽  
J. Wayne Burris ◽  
Guisou Mahmoud ◽  
Gregory Guldner
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Resident Physician ◽  
Transitions Of Care ◽  
Transition Of Care ◽  
Standardized Protocol ◽  
The Mean ◽  
System Errors ◽  
The Impact ◽  
Research Assistants

Abstract Background The Accreditation Council for Graduate Medical Education requirements for systems-based practice state residents are expected to participate in identifying system errors and implementing potential systems solutions. The objective of this study was to determine the numbers of perceived errors occurring from patient pass offs between resident physicians in our emergency department. Methods Using a prospective observational study, we queried emergency medicine residents about perceived errors in the transition of care using trained research assistants and a standardized protocol. Transition of care was defined as the transfer of responsibility to evaluate and treat and disposition of a patient in the emergency department from 1 resident physician to a second oncoming emergency department resident physician. Mean resident-perceived errors per shift and per patient transfer of care were calculated. Additionally, the mean number of perceived errors impacting patients was calculated. Results Emergency medicine residents on 107 shifts reported receiving 713 patients in pass off with a mean of 7 patients per physician per shift, with 40% of patients passed off needing some intervention (mean of 2.8 patients per provider per shift). Nineteen of the 107 shifts (17.8%) during which a resident took patients from a prior provider had a perceived error in at least 1 patient signed off. Of the 713 patients transitioned, the receiving physician perceived an error related to the transition of care for 23. Two of the 23 errors were determined by reviewing emergency medicine attendings to not be errors, and for 9 the receiving physician perceived an impact on the patient. All were delays in care or disposition. Conclusion Our data suggest emergency medicine residents were able to perceive errors related to transitions of care, describe the types of pass-off errors, and, to a lesser degree, describe the impact these errors have on patients.

scholarly journals P118: Older adults in the emergency department: a retrospective cross-sectional study of the geriatric population in Edmonton emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S106-S107
Author(s):  
K. Morch ◽  
R. Schonnop ◽  
A. Gauri ◽  
D. Ha
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Geriatric Patient ◽  
Geriatric Patients ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Region ◽  
Area Of Interest ◽  
Ed Visits

Introduction: The geriatric patient population accounts for an ever increasing proportion of emergency department (ED) visits. Geriatric centered EDs are an emerging area of interest and research. Though there have been past studies looking at older patient presentations at individual hospitals, there is limited data describing geriatric presentations within an entire Canadian geographic health region. This study characterizes the population of older adults utilizing the EDs in the Edmonton Zone, a health region that comprises a total of eleven tertiary (T), urban community (UC) and rural community (RC) hospitals. Methods: This retrospective cross-sectional study targeted all patients ≥65 years presenting to the Edmonton Zone EDs between April 1, 2017 to March 31, 2018. Data was extracted from the Emergency Department Information System (EDIS) database for ten EDs in the health region. Clinical and administrative data points were extracted and examined for each site. Results: We analyzed 100,813 ED geriatric patient visits during our study period, accounting for 18.7% of total ED visits to the Edmonton Zone. The five most common triage complaints at ED presentation were shortness of breath, abdominal pain, chest pain with cardiac features, general weakness, and back pain. CTAS scores 1-3 were assigned to 77.8% of geriatric presentations (T: 86.3%, UC: 77.4%, RC: 60.9%). 27.3% of geriatric patients had presented to an ED within the past 30 days (T: 30.0%, UC: 25.4%, RC: 27.7%). On average, 35.3% of older adult ED visits involved a consultation (T: 51.7%, UC 30.8%, RC 14.6%) and approximately 25% of geriatric patients were admitted to hospital during their ED visit (T: 42.8%, UC: 19.4%, RC: 7.1%). The average length of stay (LOS) in the ED (hh:mm) was 10:19 (T: 10:24, UC: 11:38, RC: 5:43). Overall, 2.4% of all geriatric patients left an ED without being seen after initial registration (T: 2.7%, UC: 2.2%, RC: 2.1%). Conclusion: Older adults represent a significant proportion of the ED visits in the Edmonton Zone. The triage acuity, LOS, re-presentation, consultation and admission rates varied based on the type of ED, which has implications for resource allocation within the health region. Our results can also direct future targeted initiatives and quality improvement projects to the various types of EDs in the Edmonton Zone, and facilitate planning of ED services for older adults in other health regions who have a similar geographic distribution of care sites.

scholarly journals 244 A Four-Year Descriptive Analysis of Geriatric Patient Visits to the Emergency Department

2017 ◽  
Vol 70 (4) ◽  
pp. S97
Author(s):  
A.A. Kreshak ◽  
V.T. Tolia ◽  
T.C. Chan ◽  
J.P. Killeen ◽  
G.M. Vilke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Patient ◽  
Descriptive Analysis

scholarly journals Emergency department physicians’ distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities

2021 ◽  
Author(s):  
Lisbeth D. Nymoen ◽  
Therese Tran ◽  
Scott R. Walter ◽  
Elin C. Lehnbom ◽  
Ingrid K. Tunestveit ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observation Time ◽  
Transitions Of Care ◽  
Healthcare Personnel ◽  
Bootstrap Analysis ◽  
Time Motion ◽  
Motion Study ◽  
Efficient Information ◽  
Observation Method ◽  
A Minor

AbstractBackground In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient’s drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians’ activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients’ drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

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