The Charles V. Keating Emergency and Trauma Centre is located in the academic health sciences centre in Halifax, Nova Scotia. There are approximately 16,000 visits by patients 65 years and older every year. Of these patients, 30% are admitted.
Our department had been experiencing overcrowding for many years. We were concerned about the unintended consequences of a long ED stay for older patients, including a sub-optimal experience. Through a series of in-depth interviews we learned that ED staff, physicians and patients/caregivers share concerns about the nature of the ED experience and ideas for low cost ways to improve it.
We learned about a volunteer-based program in one ED in New York City that aims to provide extra support, and reduce potentially preventable harms for older patients (You can read more about this study here). We thought it could work in our department. Trained volunteers deliver interventions at the bedside to “engage and re-orient” high-risk, older patients (e.g., patients expected to be in the ED for a long time and/or who have no family or other supports).
We worked with Volunteer Services to develop a role description and started recruiting volunteers in November 2014. Each volunteer does one 3-hour shift per week. Although the number of volunteers has varied, it has ranged from 3-11. At the beginning of a shift, the volunteer usually checks in with the Discharge Planning Nurse (DPN), NP and/or staff nurses to identify potentially suitable patients. They are self-directed during a shift and look to help make a patient’s time in the ED as comfortable as possible. Most commonly, they provide re-orientation (as needed), distraction, support and listening. Volunteers also offer comfort kits with toiletries, reading glasses , writing materials and sound amplification devices. They check with nurses re: any contra-indications before providing food or fluids. We started with 2-3 volunteers and gradually grew the program to provide volunteer coverage from Monday to Friday for 6-9 hours each day. During a shift, a volunteer typically spends time with 1-5 patients.
The Challenges and Drivers
We sought input from staff, patients and caregivers prior to starting the program and regularly seek informal feedback. It’s essential to choose volunteers with the ‘right fit’ – excellent judgment and communication skills, respectfulness and a genuine desire to spend time with older patients. ‘Branding’ has helped with the visibility of the program (e.g., logo, purple t-shirts). DPNs and our NP are front-line champions of the program.
The main challenges are variability in the consistency of volunteers’ schedules and in the number of patients referred to the program by staff (e.g., usually quieter in the summer).
Cost: Our hospital Foundation has contributed to the cost of comfort kits. The program needs one person, ideally within the department, to ‘manage’ volunteer recruitment, training and ongoing support (1-3 hours per week).
Informal, but consistent feedback is that the program seems to be mutually beneficial to patients/caregivers and ED staff (e.g., frees up staff time & helps alleviate anxiety for some patients through distraction and reassurance). Data collection for first 18 months of the program consisted of an end-of-shift journal entry by the volunteer. Electronic data collection started in June 2016 with a plan to link it with patient-level data to study impact on patient outcomes.
More information: Stacy.Ackroyd@dal.ca