Geriatric support in the emergency department: a national survey in Belgium

Els Devriendt,Johan Flamaing,Pieter Heeren,Lies Vandersaenen,Simon Conroy,Marc Sabbe,Isabelle De Brauwer,Benoit Boland,Koen Milisen

doi:10.1186/s12877-017-0458-8

Abstract

BackgroundOlder people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals.MethodsAn electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected. Descriptive analyses were performed at national level.ResultsForty-nine of 100 surveys were completed by the GS. The heads of the ED returned only 12 incomplete questionnaires and these results are therefore not reported.Twenty-six of the 49 heads of GSs (53%) indicated that there was an agreement, mainly informal, between the geriatric and the emergency department concerning the management of older people on the ED.A geriatrician was available for specific problems, by phone or in person, in 96% of the EDs during daytime on weekdays. Almost all responding hospitals (96%) had an inpatient geriatric consultation team, of which 85% was available for specific problems at the ED, by phone or bedside during the daytime on weekdays. Twenty-nine heads of the GSs (59%) reported that older patients were screened at ED admission during the day to identify ‘at risk’ patients. The results of the screening were used in the context of further treatment (76%), to decide on hospital admission (27%), or to justify admission on a geriatric ward (55%). In the year preceding the survey, 25% of the responding hospitals had organised geriatric training for ED healthcare workers. Thirty-four heads of the GS (69%) felt that the infrastructure of the ED was insufficient to give high-quality care for older persons.ConclusionCollaborations between EDs and GS are emerging in Belgium, but are currently rather limited and not yet sufficiently embedded in the ED care. Exploratory studies are necessary to identify how these collaborations can be improved.

Highlights

Older people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED
This study demonstrated that already most of the surveyed hospitals allow a referral by the ED or by the general practitioner to the geriatric day hospital
In conclusion, some collaboration between ED and geriatric services (GS) is emerging in Belgium, but is currently rather limited and not yet sufficiently embedded in the ED care

Summary

Introduction

Two single centre cohort studies in two different hospitals in Belgium showed that older people admitted to the ED had a mean age of above 80 years old [4, 5]. The majority of these older patients’ lives at home, before ED admission and more than half had at least one fall incident in the last year. Underestimation of health care problems and functional decline after ED discharge are common in older ED patients [7,8,9] They are more likely to be admitted to the hospital and experience more unplanned readmissions after ED discharge compared to a younger population [7,8,9]. There is a need to better understand how the ED environment and care processes can be attuned to the needs of older people [1]

Results

Discussion

Conclusion