scholarly journals Geriatric Emergency Department Innovations: The Impact of Transitional Care Nurses on 30‐day Readmissions for Older Adults

2019 ◽  
Vol 27 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Scott M. Dresden ◽  
Ula Hwang ◽  
Melissa M. Garrido ◽  
Jeremy Sze ◽  
Raymond Kang ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Transitional Care ◽  
The Impact

Pharmacist-Led Transition of Care Pilot Targeting Older People After Emergency Department Discharge

2020 ◽  
Vol 35 (6) ◽  
pp. 273-282
Author(s):  
Scott M. Pearson ◽  
Anushka Tandon ◽  
Danielle R. Fixen ◽  
Sunny A. Linnebur ◽  
Gretchen M. Orosz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Primary Outcome ◽  
Transitional Care ◽  
Intervention Group ◽  
Chronic Obstructive ◽  
P Value ◽  
Historical Cohort ◽  
Obstructive Pulmonary Disease ◽  
The Impact

OBJECTIVE: To evaluate the impact of a pharmacist-led transitional care intervention targeting high-risk older people after an emergency department (ED) visit.<br/> DESIGN: Retrospective cohort study of older people with ED visits prior to and during a pharmacist-led intervention.<br/> SETTING: Patients receiving primary care from the University of Colorado Health Seniors Clinic.<br/> PARTICIPANTS: The intervention cohort comprised 170 patients with an ED visit between August 18, 2018, and February 19, 2019, and the historical cohort included 166 patients with an ED visit between August 18, 2017, and February 19, 2018. All included patients either had a historical diagnosis of heart failure or chronic obstructive pulmonary disease, or they had an additional ED visit in the previous six months.<br/> INTERVENTIONS: The pilot intervention involved postED discharge telephonic outreach and assessment by a clinical pharmacist, with triaging to other staff if necessary.<br/> MAIN OUTCOME MEASURE: The primary outcome was the proportion of patients with at least one repeat ED visit, hospitalization, or death within 30 days of ED discharge. Outcome rates were also assessed at 90 days postdischarge.<br/> RESULTS: The primary outcome occurred in 21% of the historical cohort and 25% of the intervention cohort (adjusted P-value = 0.48). The incidence of the composite outcome within 90 days of ED discharge was 43% in the historical group compared with 38% in the intervention group (adjusted P-value = 0.29).<br/> CONCLUSION: A pharmacist-led telephonic intervention pilot targeting older people did not appear to have a significant effect on the composite of repeat ED visit, hospitalization, or death within 30 or 90 days of ED discharge. A limited sample size may hinder the ability to make definitive conclusions based on these findings.

scholarly journals Transitions to Long-Term Residential Care Settings

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 223-223
Author(s):  
Bram de Boer ◽  
Hilde Verbeek ◽  
Joseph Gaugler
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Transitional Care ◽  
Care Transitions ◽  
Theory And Practice ◽  
Term Care ◽  
Residential Care Facility ◽  
Increased Risk ◽  
The Impact

Abstract During their life course, many older adults encounter a transition between care settings, for example, a permanent move into long-term residential care. This care transition is a complex and often fragmented process, which is associated with an increased risk of negative health outcomes, rehospitalisation, and even mortality. Therefore, care transitions should be avoided where possible and the process for necessary transitions should be optimised to ensure continuity of care. Transitional care is therefore a key research topic. The TRANS-SENIOR European Joint Doctorate (EJD) network builds capacity for tackling a major challenge facing European long-term care systems: the need to improve care for an increasing number of care-dependent older adults by avoiding unnecessary transitions and optimising necessary care transitions. During this symposium, four presenters from the Netherlands and Switzerland will present different aspects of transitions into long-term residential care. The first speaker presents the results of a co-creation approach in developing an intervention aimed at preventing unnecessary care transitions. The second speaker presents an overview of interventions aiming to improve a transition from home to a nursing home, highlighting the clear mismatch between theory and practice. The third speaker presents the impact of the COVID-19 pandemic on transitions into long-term residential care using an ethnographic study in a long-term residential care facility in Switzerland. The final speaker discusses the results of a recent Delphi study on key factors influencing implementing innovations in transitional care. The discussant will relate previous findings on transitional care with a U.S. perspective.

Multicomponent exercise program in older adults with lung cancer during adjuvant/palliative treatment: A secondary analysis of an intervention study

2021 ◽  
pp. 1-7
Author(s):  
N. Martínez-Velilla ◽  
M.L. Saez de Asteasu ◽  
R. Ramírez-Vélez ◽  
I.D. Rosero ◽  
A. Cedeño-Veloz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Older Adults ◽  
Emergency Department ◽  
Palliative Treatment ◽  
Secondary Analysis ◽  
Exercise Programme ◽  
Control Group ◽  
Post Intervention ◽  
Frailty Status ◽  
The Impact

Background: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. Design: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. Setting: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. Participants: Newly diagnosed patients with NSCLC stage I–IV. Intervention: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45–50 minutes, and the exercise protocol was performed twice a week over 10 weeks. Measurements: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. Results: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. Conclusions: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

scholarly journals An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department

2017 ◽  
Vol 32 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Jason M. Moss ◽  
William E. Bryan ◽  
Loren M. Wilkerson ◽  
Heather A. King ◽  
George L. Jackson ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Quality Improvement ◽  
Older Adult ◽  
Quality Improvement Project ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Academic Detailing ◽  
Improvement Project ◽  
The Impact

Objective: To evaluate the impact of an academic detailing intervention delivered as part of a quality improvement project by a physician–pharmacist pair on (1) self-reported confidence in prescribing for older adults and (2) rates of potentially inappropriate medications (PIMs) prescribed to older adults by physician residents in a Veteran Affairs emergency department (ED). Methods: This quality improvement project at a single site utilized a questionnaire that assessed knowledge of Beers Criteria, self-perceived barriers to appropriate prescribing in older adults, and self-rated confidence in ability to prescribe in older adults which was administered to physician residents before and after academic detailing delivered during their emergency medicine rotation. PIM rates in the resident cohort who received the academic detailing were compared to residents who did not receive the intervention. Results: Sixty-three residents received the intervention between February 2013 and December 2014. At baseline, approximately 50% of the residents surveyed reported never hearing about nor using the Beers Criteria. A significantly greater proportion of residents agreed or strongly agreed in their abilities to identify drug–disease interactions and to prescribe the appropriate medication for the older adult after receiving the intervention. The resident cohort who received the educational intervention was less likely to prescribe a PIM when compared to the untrained resident cohort with a rate ratio of 0.73 ( P < .0001). Conclusion: Academic detailing led by a physician–pharmacist pair resulted in improved confidence in physician residents’ ability to prescribe safely in an older adult ED population and was associated with a statistically significant decrease in PIM rates.

scholarly journals 152 Implementation of Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Comfort Adedokun ◽  
Rosa McNamara ◽  
Nessa O’Herlihy
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Older People ◽  
Rapid Assessment ◽  
Admission Rate ◽  
Clinical Decision ◽  
Admission Rates ◽  
Clinical Decision Unit ◽  
Medical Referral ◽  
The Impact

Abstract Background The Emergency Department (ED) is where most people, including older adults in crises, seek care. OPRAH was introduced in order to meet the needs of our changing population. The unit was developed out of existing resources within the ED and cohorts both older patients and staff to an area more suitable to carry out assessments. Methods We used a quality improvement framework to develop our service. OPRAH is led by an ED GEM (Geriatric Emergency Medicine) consultant, staffed using the existing ED team, housed within footprint of the ED as part of the Clinical Decision Unit (CDU) with the addition of an HCA (healthcare assistant) as required. To determine the impact of the service on admissions of older adults, we collated patient records prospectively. These were reviewed and coded by senior ED professionals blinded to outcomes, to determine medical-referral rate for admission in these cohort. Results In the first 3 weeks of implementation, 76 patients were assessed. Four were admitted and 2 transferred to other hospitals. Mean age was 83 years ranging 66-103 years with an average of 262 minutes in the ED prior to OPRAH admission. Blinded coders review determined 53 (76%) of these patients would have been referred for admission. The majority of the remainder would have completed their care in the ED, as they were not eligible for admission to CDU. Conclusion Introduction of OPRAH to the ED has improved access for older people to short-stay ED led care and reduced admission rates. We have identified a trend towards fewer episodes where care by in-house teams is completed within the ED. We are in an early phase of this project. Nonetheless, it is evident that by redesigning how we assess older people in the ED and using available outpatient resources, we could impact on admission rate and length of stay in the ED without compromising patient care. Implementation has increased the use of the integrated care team, hospital and community MDT (multidisciplinary team).

scholarly journals THE IMPACT OF THE OPIOID CRISIS ON OLDER ADULTS: INSIGHTS FROM THE EMERGENCY DEPARTMENT

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 437-437
Author(s):  
M Carter ◽  
B Yang ◽  
M Davenport ◽  
A Kabel
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Opioid Crisis ◽  
The Impact

scholarly journals Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation

2021 ◽  
pp. emermed-2020-210168
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Nadia Koster ◽  
Carolien Tolsma ◽  
Maartje Munsterman ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Transitional Care ◽  
Knowledge Retention ◽  
Self Management ◽  
Academic Hospital ◽  
Discharge Instructions ◽  
Discharge Care ◽  
Full Knowledge

ObjectivesWith the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients’ retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions.MethodsA nonrandomised pre–post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8–30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions.ResultsA total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8–30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back.ConclusionsDischarging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.

scholarly journals ACE Model for Older Adults in ED

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 24 ◽  
Author(s):  
Martine Sanon ◽  
Ula Hwang ◽  
Gallane Abraham ◽  
Suzanne Goldhirsch ◽  
Lynne Richardson ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
High Risk ◽  
Hospital Admission ◽  
Transitional Care ◽  
Physical Therapist ◽  
Functional Decline ◽  
Interdisciplinary Team ◽  
Care Plans ◽  
Ace Model

The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.

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