Abstract
BackgroundCombining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs.MethodsThe revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies.ResultsSixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies.ConclusionThis scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.
Highlights
Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs
As comprehensive geriatric assessment (CGA) can be time consuming and emergency departments (ED) can have short targets for length of stay (LOS), integrating geriatric emergency guidelines in the regular ED setting is perceived challenging. Integration of these guidelines seems more compatible with the concept of emergency observation units (EOUs) [11,12,13]
These units traditionally focus on patients requiring a longer period of time for further diagnostic testing, reassessment, therapeutic interventions or consultations, which is beyond the scope of the conventional ED stay
Summary
Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. This growing segment of the ED population includes a vulnerable subgroup, which is characterized by multimorbidity, polypharmacy and reduced physical and psychosocial reserves Under these circumstances, older ED patients are at increased risk for unfavorable outcomes, such as death, prolonged ED length of stay (LOS), unnecessary admission and unplanned readmission, compared to their younger counterparts [2,3,4,5]. Older ED patients are at increased risk for unfavorable outcomes, such as death, prolonged ED length of stay (LOS), unnecessary admission and unplanned readmission, compared to their younger counterparts [2,3,4,5] To enhance these outcomes and better meet the complex needs of this vulnerable group, geriatric emergency guidelines recommend to integrate principles of comprehensive geriatric assessment (CGA) in emergency care [6, 7]. The additional available time in EOUs provides an opportunity for comprehensive, interdisciplinary assessment and focused geriatric care as a means for more appropriate risk stratification, management or disposition planning [11, 12]
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