scholarly journals Acceptability of older patients’ self-assessment in the Emergency Department (ACCEPTED)—a randomised cross-over pilot trial

2019 ◽  
Vol 48 (6) ◽  
pp. 875-880
Author(s):  
Valérie Boucher ◽  
Marie-Eve Lamontagne ◽  
Jacques Lee ◽  
Pierre-Hugues Carmichael ◽  
Julien Déry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Qualitative Data ◽  
Pilot Trial ◽  
Research Assistant ◽  
Self Assessment ◽  
Clinical Frailty Scale ◽  
Use Of Technology ◽  
Standard Assessment ◽  
Patient Self Assessment

Abstract Background patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. Objective to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. Design randomised crossover pilot study. Setting The Hôpital de l’Enfant-Jésus (CHU de Québec–Université Laval) (2018/05–2018/07). Subjects (1) ED patients aged ≥65, (2) their caregiver, if present. Methods participants’ frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. Results sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. Conclusions our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.

scholarly journals MP35: Acceptability of older patients’ self-assessment in the emergency department (ACCEPTED) – a randomized cross-over trial

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S55
Author(s):  
V. Boucher ◽  
M. Lamontagne ◽  
J. Lee ◽  
P. Carmichael ◽  
J. Déry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Qualitative Data ◽  
Small Sample Size ◽  
Statistical Tests ◽  
Age Groups ◽  
Small Sample ◽  
Self Assessment ◽  
Use Of Technology ◽  
Patient Self Assessment

Introduction: It is recommended that seniors consulting to the Emergency Department (ED) undergo a comprehensive geriatric screening, which is difficult for most EDs. Patient self-assessment using electronic tablet could be an interesting solution to this issue. However, the acceptability of self-assessment by older ED patients remains unknown. Assessing acceptability is a fundamental step in evaluating new interventions. The main objective of this project is to compare the acceptability of older patient self-assessment in the ED to that of a standard assessment made by a professional, according to seniors and their caregivers. Methods: Design: This randomized crossover design cohort study took place between May and July 2018. Participants: 1) Patients aged ≥65 years consulting to the ED, 2) their caregiver, when present. Measurements: Patients performed self-assessment of their frailty, cognitive and functional status using an electronic tablet. Acceptability was measured using the Treatment Acceptability and Preferences (TAP) questionnaires. Analyses: Descriptive analyses were performed for sociodemographic variables. Scores were adjusted for confounding variables using multivariate linear regression. Thematic content analysis was performed by two independent analysts for qualitative data collected in the TAP's open-ended question. Results: A total of 67 patients were included in this study. Mean age was 75.5 ± 8.0 and 55.2% of participants were women. Adjusted mean TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively. We found no difference between the two types of evaluations (p = 0.0831). When patients are stratified by age groups, patients aged 85 and over (n = 11) showed a difference between the TAPs scores, 2.27 for RA evaluation and 1.72 for patient self-assessment (p = 0.0053). Our qualitative data shows that this might be attributed to the use of technology, rather than to the self-assessment itself. Data from 9 caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. However, this relatively small sample size prevented us to perform statistical tests. Conclusion: Our results show that older patients find self-assessment in the ED using an electronic tablet just as acceptable as a standard evaluation by a professional.

scholarly journals 218 Swallowing/Communication Screening in Older Adults Attending the Emergency Department and Association with Clinical Frailty Scale Scores

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Orla Boyle ◽  
Louise Kelly ◽  
Maeve Ryan ◽  
Deirdre Brady ◽  
Ruth Wade ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Screening Tool ◽  
Future Research ◽  
Language Therapy ◽  
Clinical Frailty Scale ◽  
Acute Setting ◽  
Communication Difficulties ◽  
Scale Scores ◽  
High Level

Abstract Background Dysphagia, frailty and negative patient outcomes are interlinked1. Changes in communication may result from the ageing process, chronic conditions, and/or neurologic conditions presenting in later years2. However, unlike other cohorts, including stroke, frail older patients are not routinely screened for swallowing/communication difficulties in acute settings. We investigated the proportion of Speech and Language Therapy (SLT) referrals generated for older patients attending our Emergency Department (ED) following use of a swallowing/communication screening tool and their association with Clinical Frailty Scale (CFS) scores. Methods A retrospective analysis of data collected over a four week period was completed. Older patients presenting to ED were screened by the interdisciplinary gerontological ED team using a screening tool, including a locally developed swallow/communication screen. Statistical analyses were performed using STATA Version 12. Results Of 176 patients screened (mean age 81.8 years, SD 5.9 years), median CFS score was 5 (IQR 3-6). Thirty-seven percent (66/176) of patients were referred for SLT assessment following initial screen. SLT referrals were more commonly required in patients with a CFS score of ≥4 (46.2% vs. 19.3%, P=0.001) and likelihood of requiring SLT referral increased with greater CFS score (P<0.0001). Conclusion Results suggest that screening for swallowing and communication difficulties in older patients yields a high level of SLT referrals, with a higher frequency of SLT referrals observed with increasing frailty scores. Further research is required to determine the optimum swallowing/communication screening tool in the acute setting. Future research will focus on evaluating outcomes of SLT assessments completed and determining the prevalence of swallowing and/or communication difficulties in this cohort.

The effectiveness of patient self-assessment forms at increasing emergency department efficiency

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A12.2-A12
Author(s):  
Scott Middleton
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Care Providers ◽  
Self Assessment ◽  
Patient Demographics ◽  
Included Patient ◽  
Drug History ◽  
Flow Through ◽  
Mean Time ◽  
Patient Self Assessment

IntroductionEmergency department ergonomics is an under researched topic. To our knowledge, this is the only study investigating the effectiveness of a patient self-assessment form in managing patient flow through an emergency department in a busy teaching hospital.MethodsSelf-reported information contained on the forms included patient demographics, presenting complaint, past medical, surgical and drug history, and the option to consent for the emergency care summary, which provides an up-to-date drug history from the general practitioner. This form followed the patient through the department and was utilised by the triage nurse and care providers. 200 patients in Manchester triage categories three to five were recruited, half of whom were given self-assessment forms. Time spent in triage, time taken for first assessment and total time in the department were recorded for all patients.ResultsPatients without a self-assessment form had a mean time spent in triage of 6.0± 3.6 SD min and mean time taken for first assessment of 11.0±6.0 SD min. Patients managed with a self-assessment form had a mean time spent in triage of 4.9 ±3.5 SD min and mean time taken for first assessment of 9.0±5.0 SD min. Patients without a self-assessment form had a median total time spent in the department of 201 min (range 33–301), whereas patients managed with the self-assessment form had a median time of 121 min (range 19–240). The differences in triage, first assessment and total department times between groups were significant (p<0.05).ConclusionThis pilot study showed the effectiveness of a self-assessment form at increasing patient flow through the department, reducing triage, first assessment and total department times. The reasons for this are complex and merit further investigation.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

scholarly journals Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Tina Hansen ◽  
Rikke Lundsgaard Nielsen ◽  
Morten Baltzer Houlind ◽  
Juliette Tavenier ◽  
Line Jee Hartmann Rasmussen ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Systemic Inflammation ◽  
Older Patients ◽  
Time Course ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Secondary Analysis ◽  
Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

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