The Hospital
Grand River Hospital is a large high volume community hospital located in Kitchener, Ontario. GRH receives approx. 66,500 patient ED visits per year and of this volume 16 % are of the older adult population seen in ED per year.
The Need
GRH wanted to implement a quick and easy evidence-based screening tool for the older adult population to ensure access to the appropriate resources during and after their ED visit. The implementation has also streamlined the ED RN assessment and built a common language to improve the quality of care delivered to the older adult cohort in the ED environment.
The Improvement
GRH implemented the Assessment Urgency Algorithm (AUA) to ensure comprehensive screening of older adults that is conducive to a fast paced and busy ED. The AUA is completed electronically at the bedside on all patients aged 65 years +. The screening tool “scores” the patient, and the patient is linked with appropriate resources in and outside of the ED based on the score/their needs. In doing so, the AUA ensures a senior friendly approach to assessing older adults while in the emergency department.
The Challenges and Drivers
Key metric: At GRH we measure compliance (% of AUA completed from the # of patients eligible for assessment ) of score completion by the RN in the secondary assessment phase of the patient visit.
The cost in our implementation was approx. $3000, basically the cost of the iPads and chargers as this is the device that the AUA is completed on by the patient at the bedside. The human resources capital was imbedded in the day-to-day work of the people who were involved in the project .
Challenges include compliance with screening. Drivers: We addressed this by ensuring the GEM nurse was a key stakeholder in the development and implementation of the AUA project. The GEM nurse reinforces the purpose and value of AUA screening. We did recognize early on that trying to assess and capture the AUA score in triage was not going to be successful: it became one more thing to do and did not particularly add value to the triage component of the ED visit. Compliance amongst the RN staff increased when the completion of the tool became part of the primary RN‘s assessment of the patient.
Outcomes
Positive outcomes include: engagement of community family physicians through the AUA reports being sent to the family physician about their patient’s visit to the ED positively impacted continuity of care.
Additional Comments
We find the AUA to be more sensitive and specific then previous tools used, ensuring allocation of resources appropriately. Patients and families also received AUA information specific to them on discharge that was developed by our GEM CNS and NP. This information gives the patient information to refer to and to take with them to their family physician or follow up provider.
Contact: Sarah Sullivan sarah.sullivan@grhosp.on.ca ED GEM CNS and Interim Manager of Medicine, Jill Schitka Jill.Schitka@grhosp.on.ca Director Emergency and Acute Care
