Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments

Authors

Ilianna Santangelo, Massachusetts General HospitalFollow
Surriya Ahmad, SUNY Downstate Medical Center / Kings County Hospital Center
Shan Liu, Massachusetts General Hospital / Harvard
Lauren Southerland, The Ohio State University
Christopher Carpenter, Washington University School of Medicine in St. LouisFollow
Ula Hwang, Yale School of Medicine / James J. Peters VAMC
Adriane Lesser, West Health Institute
Nicole Tidwell, American College of Emergency Physicians
Kevin Biese, University of North Carolina / West Health InstituteFollow
Maura Kennedy, Massachusetts General Hospital/HarvardFollow

Author ORCID Identifier

https://orcid.org/0000-0002-1132-6327

Abstract

Background: Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes.

Objective: The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.

Methods: This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We a priori selected 5 GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes.

Results: A total of 35 level 1 and 2 GEDs were included in this analysis.

Among care processes studied, geriatric falls was the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. With respect to medication related protocols, medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses, protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function.

Conclusion: This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeneity in how these care processes are implemented.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Santangelo, Ilianna; Ahmad, Surriya; Liu, Shan; Southerland, Lauren; Carpenter, Christopher; Hwang, Ula; Lesser, Adriane; Tidwell, Nicole; Biese, Kevin; and Kennedy, Maura (2023) "Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments," Journal of Geriatric Emergency Medicine: Vol. 3: Iss. 4, Article 3.
DOI: https://doi.org/10.17294/2694-4715.1041
Available at: https://institutionalrepository.aah.org/jgem/vol3/iss4/3