21 research outputs found
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The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in the emergency department (ED) and determine how these programs impacted patient experiences or outcomes.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 speciļ¬cally 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 signiļ¬cant 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 identiļ¬ed 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
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Approach to Geriatric Emergency Medicine: A Flipped Classroom Group Learning Exercise for Undergraduate Medical Trainees
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
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Approach to Geriatric Emergency Medicine: A Flipped Classroom Group Learning Exercise for Undergraduate Medical Trainees
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
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 (ā„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