Volunteer contributions in the emergency department: A scoping review

The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in the emergency department (ED) and determine how these programs impacted patient experiences or outcomes. Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. A grey literature search was also conducted. Two reviewers independently screened titles and abstracts, reviewed full text articles, and extracted data. The search strategy yielded 4,589 potentially relevant citations; 87 reports were included in the review. Volunteer activities were categorized as non-clinical tasks (e.g., provision of meals/snacks, comfort items and mobility assistance), navigation, emotional support/communication, and administrative duties. 52 (59.8%) programs had general volunteers in the ED and 35 (40.2%) had volunteers targeting a specific patient population, including pediatrics, geriatrics, patients with mental health and addiction issues and other vulnerable populations. 18 (20.6%) programs included an evaluative component describing how ED volunteers affected patient experiences and outcomes. Patient satisfaction, follow-up and referral rates, ED hospital costs and length of stay, subsequent ED visits, medical complications, and malnutrition in the hospital were all reported to be positively affected by volunteers in the ED. These findings demonstrate the important role volunteers play in enhancing patient and caregiver experience in the ED. Future volunteer engagement programs should be formally described and evaluated to share their success and experience with others interested in implementing similar programs in the ED. Experience Framework This article is associated with the Infrastructure & Governance lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

An approach to the older patient in the emergency department

Older patients in the emergency department (ED) present unique diagnostic and therapeutic challenges. The ED clinicians must simultaneously evaluate and treat older adults along multiple domains: cognitive impairment, atypical presentations, functional impairment, medication management, trauma and falls, and end-of-life care. This article reviews these domains and suggests strategies for a more comprehensive, patient-centered ED approach to older patients. Incorporating assessment of these domains into the ED process improves patient outcomes, provider satisfaction, and ED flow

Statement on minimum standards for the care of older people in emergency departments by the geriatric emergency medicine special interest group of the international federation for emergency medicine

Pathophysiology, epidemiology and therapy of agein

Describing and Predicting Trajectories of Healthcare Utilization Among Older Adults Presenting to an Emergency Department Using the interRAI Emergency Department Screener

Introduction: Although older adults visit emergency departments (EDs) more than any other age group, the trajectories of healthcare utilization older adults experience post-ED are not well described. Further, whether rapid ED assessment tools can predict trajectories and discharge destinations remains unclear. Methods: Older adults (≥65 years) who presented to an ED at a large Canadian urban academic hospital were recruited (January 2018-April 2019). The interRAI ED Screener (EDS) was completed on presentation. Patients were categorized by EDS risk score (1/2=low, 3/4=moderate, 5/6=high) and had their discharge destinations tracked. Patients admitted to hospital were tracked until their final discharge destination. Crude and age/sex-adjusted odds ratios and c-statistics were obtained to examine associations between EDS scores and discharge destinations. Results: Of 751 patients (mean/SD age 77.68/8.43; 41.3% male), 200/26.6% had a high-risk EDS score. 58.3% were discharged home, 39.7% were admitted to hospital, and 2.0% were discharged to rehabilitation/long-term care (LTC) settings directly from the ED. The high-risk group had lower odds of home discharge (aOR=0.47, 95%CI 0.31-0.71, ppp=0.038) and have a geriatrician consulted (aOR=3.72, 1.17-11.86, p=0.026). The EDS had poor prediction of post-ED hospitalization (C-statistic=0.58, 95%CI 0.54-0.62), but reasonable prediction of post-ED LTC home/rehabilitation centre admission (0.75, 0.63-0.87), albeit the number of these outcomes were small (n=15). Conclusions: We describe a range of healthcare trajectories older adults experience following ED presentation. Stratification by EDS risk groups could help to proactively identify the need for geriatric consultation earlier and resource utilization trajectories after an index ED visit, which could better enable the planning and organization of acute healthcare services for older adults

Level of Comfort in Evaluating Older Patients Amongst Medical Students and Emergency Medicine Residents

Introduction As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM). Methods We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, in addition to exploring GEM education and interest. Results 169 trainees participated in the survey, 71% of which were medical students and 29% of which were residents. A majority of medical students (66%) and residents (92%) overall reported comfort evaluating and managing older patients in the ED, but comfort varied with each competency domain. Year of training within these groups was not reliably predictive of increased comfort across the various domains. Common barriers to learning more about GEM identified include exposure in medical education and training for medical students and residents, at 59% and 65% respectively. Medical students also noted that more exposure in preclinical and clinical training would increase interest in GEM, at 57% and 54%, respectively. For residents, learning more about what a career in GEM looks like would increase interest in GEM (51%). Common resources used to learn about older patients were society guidelines for medical students (56%) and UpToDate for residents (82%). Only 30% of medical students noted that their medical school offers a dedicated geriatric curriculum, and medical students whose medical school offered a geriatrics curriculum reported more comfort in evaluating and managing older patients in the ED. Conclusion While the majority of trainees surveyed felt comfortable in the geriatric core competencies, increased geriatrics exposure in preclinical and clinical training could increase interest in GEM. Such exposure may be best accomplished earlier in medical training and will be important in creating a future EM physician workforce that is competent in caring for this complex and important patient population