Santangelo Ilianna, Ahmad Surriya, Liu Shan, Southerland Lauren T, Carpenter Christopher, Hwang Ula, Lesser Adriane, Tidwell Nicole, Biese Kevin, Kennedy Maura
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
SUNY Downstate Medical Center / Kings County Hospital Center.
J Geriatr Emerg Med. 2022 Winter;3(4). doi: 10.17294/2694-4715.1041. Epub 2023 Feb 17.
Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.
This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We selected five GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes.
A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls were the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing the use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function, and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. Medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses. Protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function.
This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeny in how these care processes are implemented.
老年人在人口中所占比例很大且不断增长，在急诊科（ED）环境中有独特的护理需求。老年急诊科认证计划旨在通过规范经认证的老年急诊科（GED）提供的护理以及实施针对老年人的护理流程，来改善为老年人提供的急诊护理。本研究的目的是评估经认证的一级和二级GED的特定护理流程。
这是一项对2018年5月7日至2021年3月1日期间获得认证的一级和二级GED队列的横断面分析。我们选择了五个GED护理流程进行分析：与谵妄相关的举措、痴呆筛查、功能及功能衰退评估、老年跌倒以及尽量减少与药物相关的不良事件。对于所有方案，一名经过培训的研究助理提取了有关所使用的工具或护理流程、接受干预的患者以及参与护理流程的工作人员的信息；针对各个护理流程还提取了其他特定信息。
本分析共纳入35个一级和二级GED。在所研究的护理流程中，老年跌倒最为常见（31个GED，89%），其次是老年疼痛管理（25个GED，71%）、尽量减少使用潜在不适当药物（24个急诊科，69%）、谵妄（22个GED，63%）、用药核对（21个GED，60%）、功能评估（20个GED，57%）和痴呆筛查（17个GED，49%）。对于与谵妄、痴呆、功能和老年跌倒相关的方案，各机构使用了一系列不同的筛查工具，在进行筛查的人员以及评估的患者方面存在异质性。用药核对方案借助了药剂师、药房技术员和/或护士。避免潜在不适当药物给药的方案通常侧重于急诊科的药物给药，并使用了《老年人潜在不适当用药筛查工具》标准，很少有机构表明疼痛药物方案是否针对年龄和/或肾功能进行了剂量调整。
本研究提供了一级和二级认证GED中实施的护理流程的概况，并表明这些护理流程的实施方式存在显著异质性。
