Taylor Andrea, Broadbent Marc, Gurung Apil, Wallis Marianne
University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs Queensland 4556, Australia; Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya Queensland 4575, Australia; Healthcare Improvement Unit, Clinical Excellence Queensland, Level 2, 15 Butterfield Street, Herston, Queensland 4006, Australia.
University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs Queensland 4556, Australia.
Int Emerg Nurs. 2021 Mar;55:100847. doi: 10.1016/j.ienj.2020.100847. Epub 2020 Mar 20.
The universal screening and comprehensive assessment of older persons presenting to the emergency department is considered useful, yet is difficult to embed. A number of assessment instruments exist however they are not widely used and there is a lack of agreement between clinicians as to which tools are best suited to the emergency department. The aim of this study was to develop a modified comprehensive geriatric assessment using consensus methodology for use by the multidisciplinary team in the emergency department.
The modified comprehensive geriatric assessment was formulated using the RAND/UCLA appropriateness methodology incorporating consensus opinion from an expert group of clinicians and the best scientific evidence available. A series of pre and post survey and expert group meetings were held with expert multidisciplinary clinicians. Emphasis was placed on a pragmatic approach to the development of a document which reflected consensus opinion.
Between nine and 15 expert group members participated in the stages of the process. A tiered approach incorporating different aspects of screening and/or assessments was considered optimal to reflect the stages of decision-making in the emergency department process.
A unique approach to the screening and assessment of the frail older person was developed using consensus methodology to develop a modified comprehensive geriatric assessment for use in the emergency department. Associated actions and interventions are an important next step, with pilot site testing.
对前往急诊科就诊的老年人进行全面筛查和综合评估被认为是有用的，但难以实施。现有的一些评估工具并未得到广泛应用，而且临床医生对于哪些工具最适合急诊科缺乏共识。本研究的目的是采用共识方法开发一种改良的综合老年评估方法，供急诊科的多学科团队使用。
采用兰德/加州大学洛杉矶分校的适宜性方法，并结合临床医生专家组的共识意见和现有最佳科学证据，制定改良的综合老年评估方法。与多学科临床专家举行了一系列调查前和调查后的会议以及专家组会议。重点是采用务实的方法来制定一份反映共识意见的文件。
9至15名专家组成员参与了该过程的各个阶段。采用一种分层方法，纳入筛查和/或评估的不同方面，被认为是反映急诊科决策过程各阶段的最佳方式。
采用共识方法开发了一种独特的针对体弱老年人的筛查和评估方法，以制定一种用于急诊科的改良综合老年评估方法。相关行动和干预措施是下一步的重要工作，需要在试点地点进行测试。
