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.

scholarly journals Risk factors for frequent users of the emergency department among adults aged 55 and older

2018 ◽  
Vol 8 (9) ◽  
pp. 96 ◽  
Author(s):  
Deana Hays ◽  
Barbara Penprase ◽  
Suha Kridli
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Emergency Department ◽  
High Risk ◽  
Hospital Admissions ◽  
Transitional Care ◽  
Screening Criteria ◽  
Frequent Users ◽  
Frequent Use ◽  
Psychiatric Issues

Introduction: Excessive use of the emergency department (ED) is a major source of healthcare expenditure. ED frequent users, have been identified as a major contributing factor to a disporportionate amount of ED visits and costs, making up 20% to 30% of all annual visits. The aim of the study was to identify risk factors that place adults age 55 and older at risk for frequent ED use.Methods: The Transitional Care Model (TCM): Hospital Discharge Screening Criteria for High Risk Older Adults was used to identify risk factors for frequent use of ED services in adults 55 and older.Results and conclusions: A third of the sample (33%) had active behavioral and/or psychiatric issues. A majority of the sample (87%) had two or more hospitalizations within 6 months of a prior ED visit, and seventy-two percent were hospitalized within thirty days of an Emergency Department visit. Almost 70% had at least 1 chronic diagnosis of diabetes (41.5%), heart failure (35.8%), or COPD (28%). Most patients were between ages 70-85 years old and risk factors for ED frequent use included 4 or more coexisting health conditions, 6 or more prescription medications, previous hospital admissions, active behavioral and/or psychiatric issues. Identifying older adults at high risk for ED frequent use may provide earlier interventions and less reliance on ED use for care and treatment of chronic disorders.

scholarly journals 8 High Risk Care Plans Effectively Decrease Emergency Department Resource Utilization

2014 ◽  
Vol 64 (4) ◽  
pp. S4 ◽  
Author(s):  
L. Ablaihed ◽  
F. Barrueto ◽  
L. Pimentel ◽  
A. Comer ◽  
B.J. Browne ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Resource Utilization ◽  
Care Plans

scholarly journals A TRIAL TO IMPROVE MEDICATION SAFETY IN OLDER ADULTS: RECRUITMENT CHALLENGES HAVE GENERALIZABILITY IMPLICATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S711-S711
Author(s):  
Kathryn Anzuoni ◽  
Terry Field ◽  
Kathleen Mazor ◽  
Yanhua Zhou ◽  
Timothy Konola ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Odds Ratio ◽  
Adverse Drug Events ◽  
Functional Decline ◽  
Post Discharge ◽  
Recruitment Challenges ◽  
Hospital To Home ◽  
The Impact ◽  
Visiting Nurse

Abstract For older adults, the transition from hospital to home is a high-risk period for adverse drug events, functional decline, and hospital readmission. Randomized trials of interventions to improve this transition must recruit potential subjects immediately after hospital discharge, when people are recovering and tired. Within a randomized trial assessing the impact of a pharmacist home visit to provide medication assistance immediately post-discharge, we determined whether individuals who enrolled were comparable to those who were invited but did not enroll, and described reasons for not enrolling. Individuals ≥50 years of age discharged from the hospital and prescribed a high-risk medication were eligible. We attempted to recruit individuals by phone within 3 days of discharge, and recorded reasons for not enrolling. Of 3,606 eligible individuals reached, 3,147 (87%) declined, 361 (10%) were enrolled, and 98 (3%) were initially recruited but did not complete a consent form. Individuals ≥80 years of age (odds ratio 0.45, CI 0.25, 0.78) and those with an assigned visiting nurse (odds ratio 0.64, CI 0.48, 0.85) were least likely to enroll. Among those who provided a reason for declining (2,473) the most common reason given was the belief they did not need medication assistance (22%). An additional 332 (13%) declined because they were receiving visiting nurse services. Recruiting older adults recently discharged from the hospital is difficult and may under-enroll the oldest individuals, limiting the ability to generalize findings across older patient populations. Researchers planning RCTs among newly discharged older adults may need creative approaches to overcome resistance.

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

2019 ◽  
Vol 32 (1) ◽  
pp. 97-104
Author(s):  
Pei-Chao Lin ◽  
Li-Chan Lin ◽  
Hsiu-Fen Hsieh ◽  
Yao-Mei Chen ◽  
Pi-Ling Chou ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Retrospective Study ◽  
Older People ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
Urban Setting ◽  
Research Database ◽  
Patient Records ◽  
People With Dementia

ABSTRACTObjectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

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

scholarly journals National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED. Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥ 75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-h and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 h and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU. With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64–0.76) and 0.62 (0.56–0.68); for hospital admission prediction 0.62 (0.60–0.65) and 0.55 (0.52–0.56), and for HDU admission 0.72 (0.61–0.83) and 0.80 (0.70–0.90), respectively. The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p = 0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p < 0.001) but not between the yellow/green groups (p = 0.59). There were 48 and 351 revisits within 72 h and 30 days, respectively. With NEWS2 AUCs for 72-h and 30-day revisit prediction were 0.48 (95% CI 0.40–0.56) and 0.47 (0.44–0.51), respectively; with triage score 0.48 (0.40–0.56) and 0.49 (0.46–0.52), respectively. Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission.

Individual care plans can reduce hospital admission rate for patients who frequently attend the emergency department

2010 ◽  
Vol 28 (8) ◽  
pp. 654-657 ◽  
Author(s):  
A. Newton ◽  
S. J. Sarker ◽  
A. Parfitt ◽  
K. Henderson ◽  
P. Jaye ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Admission Rate ◽  
Hospital Admission Rate ◽  
Care Plans ◽  
Individual Care

An interdisciplinary model for predicting patients at high risk for readmission amongst solid tumor oncology patients in a comprehensive cancer center.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 190-190
Author(s):  
Arvind Shinde ◽  
Ruth Nolen ◽  
Marjorie Jen Hein ◽  
Eduardo Siccion ◽  
Laura E. Crocitto ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Progression ◽  
Primary Care Physicians ◽  
Hospice Care ◽  
Interdisciplinary Team ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Targeted Interventions ◽  
Care Plans ◽  
Increased Risk

190 Background: Increasing emphasis is being placed on reducing hospital readmission (readm) rates. Reduction of hospital readm remains a challenge, especially among the oncology population. Identifying patients (pts) at increased risk can assist with developing targeted interventions. Methods: From 1/1/11 to 12/31/12, an interdisciplinary team consisting of medical oncologists, hospitalist physician and NP, QI specialist, and case manager prospectively reviewed the medical oncology inpatient census on a biweekly basis to identify pts at risk for readm. Pts with any of the following conditions were considered at high risk for readm: significant pain, wounds, intestinal obstruction, refractory neutropenia despite GCSF, elderly/frail, unstable housing, patient/family non-compliance, rapid cancer progression, refusal of appropriate hospice care, and stalled care plans. These criteria were based upon previous years’ anecdotal experience. Interdisciplinary interventions to address these conditions were identified and initiated. Results: 272 pts were assessed during these sessions. Each session took on average 60 minutes. 69 pts (25%) were deemed to have at least one high risk factor. Chart review revealed that 6 died in the hospital and 13 were discharged to hospice. No pts on hospice were readmitted. Of the remaining 50 high risk pts, 14 (28%) and 25 (50%) pts were readmitted within 14 days and 30 days, respectively. Conclusions: This interdisciplinary team model seems to have a fair predictive value in identifying pts at higher risk for readmission. However, it is time and labor intensive. Enrollment of appropriate high risk pts in hospice mitigates this risk. Given the current emphasis on decreasing readm and the increased cost/penalties associated with readm, the next step will be to pilot cost-effective interventions for pts with these high risk factors. Potential interventions which we have instituted include follow-up calls, social service referrals, intensive family/pt education, clinic appointments within 3 days of discharge, greater coordination with primary care physicians, and more effective hospice discussions. Supported by CA 62505.

scholarly journals Virtual Geriatric Education Preferences of Rural Social Workers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 328-328
Author(s):  
Joan Ilardo ◽  
Raza Haque ◽  
Angela Zell
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Social Workers ◽  
Online Survey ◽  
Transitional Care ◽  
Healthcare Services ◽  
Multiple Chronic Conditions ◽  
Care Plans ◽  
Health Practitioners ◽  
Geriatric Service

Abstract Older adults in rural communities need access to comprehensive healthcare services provided by practitioners equipped with geriatric knowledge and skills. The Geriatric Rural Extension of Expertise through Telegeriatric Service (GREETS) project goal is to use telemedicine and telehealth to expand geriatric service options to underserved Michigan regions. GREETS educational programs train health practitioners to provide geriatric care for vulnerable older adults. To determine gaps in geriatric competencies, the team conducted an online survey of health professionals including behavioral health practitioners. Respondents identified educational topics and preferred virtual delivery methods. Demographic information included respondent’s professional position, practice setting, and county. The respondents were asked to indicate level of educational need using a scale ranging from a low, medium, or high need. Fifty (47%) of 106 total responses were from social workers. We compared the percent of social workers to other practitioners’ responses in our analysis. Four topics emerged for both groups as medium or high educational needs: 1) transitional care when changing residential settings or post-hospitalization; 2) assisting family caregivers cope with caregiving responsibilities; 3) incorporating community-based services into care plans; and 4) and managing frail older adults. Social workers noted higher need than the other respondents for: 1) managing chronic pain; 2) managing care of patients with multiple chronic conditions; 3) having serious illness conversations; 4) diagnosing dementia; and 5) discussing advance care planning. Both social worker and other respondents indicated interactive case-based webinars; published tools, toolkits, tip sheets; and didactic webinars as their top three learning formats.

scholarly journals National Early Warning Score 2 (NEWS2) and 3-Level Triage Scale as Risk Predictors in Frail Older Adults in the Emergency Department

2020 ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED.Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-hour and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 hours and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU.With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64-0.76) and 0.62 (0.56-0.68); for hospital admission prediction 0.62 (0.60-0.65) and 0.55 (0.52-0.56), and for HDU admission 0.72 (0.61-0.83) and 0.80 (0.70-0.90), respectively.The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p=0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p<0.001) but not between the yellow/green groups (p=0.59).There were 48 and 351 revisits within 72 hours and 30 days, respectively. With NEWS2 AUCs for 72-hour and 30-day revisit prediction were 0.48 (95% CI 0.40-0.56) and 0.47 (0.44-0.51), respectively; with triage score 0.48 (0.40-0.56) and 0.49 (0.46-0.52), respectively.Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission

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