Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care : A before-after study.
Z Gerontol Geriatr
; 54(2): 113-121, 2021 Mar.
Article
em En
| MEDLINE
| ID: mdl-33471176
ABSTRACT
OBJECTIVE:
The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation.METHODS:
We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥â¯70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate.RESULTS:
Two comparable groups of patients (median age 77 years) were included before (nâ¯= 920) and after (nâ¯= 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; pâ¯= 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202â¯min before vs. 196â¯min after; pâ¯= 0.152) or hospital admission rate (40% before vs. 39% after; pâ¯= 0.410).CONCLUSION:
Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Serviços Médicos de Emergência
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Diagnostic_studies
/
Screening_studies
/
Sysrev_observational_studies
Aspecto:
Implementation_research
Limite:
Aged
/
Humans
Idioma:
En
Revista:
Z Gerontol Geriatr
Assunto da revista:
GERIATRIA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Holanda