Laura C Blomaard1, Bas de Groot2, Jacinta A Lucke2,3, Jelle de Gelder4,5, Anja M Booijen4,2, Jacobijn Gussekloo4,5, Simon P Mooijaart4,6. 1. Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands. l.c.blomaard@lumc.nl. 2. Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands. 4. Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands. 5. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. 6. Institute of Evidence-Based Medicine in Old Age | IEMO, Leiden, The Netherlands.
Abstract
OBJECTIVE: The 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. METHODS: We 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. RESULTS: Two 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). CONCLUSION: Implementation 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.
OBJECTIVE: The 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. METHODS: We 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. RESULTS: Two 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). CONCLUSION: Implementation 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.
Authors: Andreas W Schoenenberger; Christoph Bieri; Onur Özgüler; André Moser; Monika Haberkern; Heinz Zimmermann; Andreas E Stuck; Aristomenis Exadaktylos Journal: Am J Emerg Med Date: 2014-03-25 Impact factor: 2.469
Authors: Hilary Pinnock; Melanie Barwick; Christopher R Carpenter; Sandra Eldridge; Gonzalo Grandes; Chris J Griffiths; Jo Rycroft-Malone; Paul Meissner; Elizabeth Murray; Anita Patel; Aziz Sheikh; Stephanie J C Taylor Journal: BMJ Date: 2017-03-06
Authors: Laura C Blomaard; Mareline Olthof; Yvette Meuleman; Bas de Groot; Jacobijn Gussekloo; Simon P Mooijaart Journal: BMC Geriatr Date: 2021-03-20 Impact factor: 3.921
Authors: Cheng-Fu Lin; Po-Chen Lin; Sung-Yuan Hu; Yu-Tse Tsan; Wei-Kai Liao; Shih-Yi Lin; Tzu-Chieh Lin Journal: Int J Environ Res Public Health Date: 2021-06-07 Impact factor: 3.390