In Emergency Departments, we tend to follow the evidence to make practice change. However when creating a geriatric ED, the evidence sometimes is lacking: adopting or adapting “best practices” may be more appropriate. Here are some key articles that you may find valuable in your search for evidence AND best practice. Click on the title to access a pdf of the article.
Please add your own preferred articles in the comments section.
Ula Hwang and Sean Morrison from New York City in 2007 wrote a paper about how an Emergency Department can modify its model of care for the older adult population. They refer to the GEDI (Geriatric Emergency Department Intervention) that they have implemented in their ED. Does it work? They don’t say, it is mostly descriptive but the guidelines found an inspiration there.
2. A Systematic Review and Qualitative Analysis to Inform the Development of a New Emergency Department-Based Geriatric Case Management Model
Samir Sinha et al. in 2011 published a systematic review about models of care in the emergency department. Of the 352 articles they reviewed, the successful EDs shared mainly eight characteristics: based on evidence; involved nursing leadership; included high risk screening; focussed geriatric assessment; disposition planning early in the ED visit; interdisciplinary team; post-discharge follow-up; and monitoring of processes.
Jane McCusker et al. in Montreal in 2003 did a randomized controlled study on high risk older adults. The intervention was to have a focussed geriatric assessment by a specialized nurse who could refer the patient to community services, hospital outpatient clinics or to their primary care physicians. This is a rare randomized controlled trial about geriatric emergency care.
4. The Elder-Friendly Emergency Department Assessment Tool: Development of a Quality Assessment Tool for Emergency Department–Based Geriatric Care
This article follows the work of the previous study (number 3) by the same research group from Montreal. And provides a practical brief check-list of the essential features of an elder-friendly ED.
Adams and Gerson in 2003 wrote a brilliant commentary about the new model for emergency care in geriatric patients.
Corbett et al. in 2005 in Australia published a quality improvement (QI) research about a care intervention for older adults and its effect on admission and revisit. This is a good example of a well reported QI project.
7. Geriatric Emergency Department Innovations: Preliminary Data for the Geriatric Nurse Liaison Model
Aldeen et al. developed in 2013 in Chicago a brief training for geriatric specialized nurses and studies the impact of their work compared to usual care. They found a significative admission reduction.
Matthew Cooke, Jay Banerjee et al. in England wrote the Silver Book, which sets quality standards for the emergent and urgent care of older people who are ill or injured. It is a rich and comprehensive resource that brought together practitioners from 14 different disciplines.
9. Four Sensitive Screening Tools to Detect Cognitive Dysfunction in Geriatric Emergency Department Patients: Brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the Caregiver- completed AD8
This is a great review of cognitive impairment screening tools for the Emergency Department published by Carpenter et al. in 2011.
10. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls
And finally, if you are interested in research, Carpenter et al. in 2011 identified several high yield research questions in geriatric emergency medicine.
References and Resources
- Hwang U, Morrison RS. The geriatric emergency department. Journal of the American Geriatrics Society. 2007 Nov;55(11):1873-6. PubMed PMID: 17916122
- Sinha SK, Bessman ES, Flomenbaum N, Leff B. A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model. Annals of emergency medicine. 2011 Jun;57(6):672-82. PubMed PMID: 21621093.
- McCusker J, Verdon J, Vadeboncoeur A, Levesque JF, Sinha SK, Kim KY, et al. The elder-friendly emergency department assessment tool: development of a quality assessment tool for emergency department-based geriatric care. Journal of the American Geriatrics Society. 2012 Aug;60(8):1534-9. PubMed PMID: 22860623.
- McCusker J, Dendukuri N, Tousignant P, Verdon J, Poulin de Courval L, Belzile E. Rapid two-stage emergency department intervention for seniors: impact on continuity of care. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2003 Mar;10(3):233-43. PubMed PMID: 12615589.
- Adams JG, Gerson LW. A new model for emergency care of geriatric patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2003 Mar;10(3):271-4. PubMed PMID: 12615594.
- Corbett HM, Lim WK, Davis SJ, Elkins AM. Care coordination in the Emergency Department: improving outcomes for older patients. Australian health review : a publication of the Australian Hospital Association. 2005 Feb;29(1):43-50. PubMed PMID: 15683355.
- Aldeen AZ, Courtney DM, Lindquist LA, Dresden SM, Gravenor SJ. Geriatric emergency department innovations: preliminary data for the geriatric nurse liaison model. Journal of the American Geriatrics Society. 2014 Sep;62(9):1781-5. PubMed PMID: 25112656.
- Banerjee J, Conroy S, Cooke MW. Quality care for older people with urgent and emergency care needs in UK emergency departments. Emergency medicine journal : EMJ. 2013 Sep;30(9):699-700. PubMed PMID: 23250895.
- Carpenter CR, Bassett ER, Fischer GM, Shirshekan J, Galvin JE, Morris JC. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2011 Apr;18(4):374-84. PubMed PMID: 21496140. Pubmed Central PMCID: 3080244.
- Carpenter CR, Shah MN, Hustey FM, Heard K, Gerson LW, Miller DK. High yield research opportunities in geriatric emergency medicine: prehospital care, delirium, adverse drug events, and falls. The journals of gerontology Series A, Biological sciences and medical sciences. 2011 Jul;66(7):775-83. PubMed PMID: 21498881. Pubmed Central PMCID: 3143344.