Abstract
ObjectiveThe aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation.MethodsWe conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate.ResultsTwo comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410).ConclusionImplementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.Supplementary InformationThe online version of this article (10.1007/s00391-020-01837-9) contains supplementary material, which is available to authorized users.
Highlights
Older patients form an increasing proportion of emergency department (ED) admissions worldwide and are at higher risk of adverse health outcomes compared to younger patients [1]
The first effects of implementation of the acutely presenting older patient (APOP) screening program in routine ED care were evaluated after 1 month by assessing the compliance with interventions and the impact on process of care measures
Implementation of the program resulted in increased numbers of executed comprehensive geriatric assessment (CGA) during hospitalization, communication of screening results to the GP and telephone follow-up after ED discharge
Summary
Older patients form an increasing proportion of emergency department (ED) admissions worldwide and are at higher risk of adverse health outcomes compared to younger patients [1]. The presence of multiple comorbidities, cognitive disorders and atypical disease presentations requires more staff time and resources [2], increases ED length of stay (LOS) and poses organizational challenges [3, 4]. A comprehensive geriatric assessment (CGA) is an effective method to improve older patients’ outcomes [5] but CGA is time-consuming and cannot be routinely applied to every older patient attending the ED. A two-step approach can be used with identification of patients with the highest risk of adverse outcome as a first step, followed by targeted in-
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