Abstract
Background
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.
Objective
The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs.
Methods
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 a priori selected 5 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.
Results
A total of 35 level 1 and 2 GEDs were included in this analysis.
Among care processes studied, geriatric falls was the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing 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. With respect to medication related protocols, 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.
Conclusion
This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeneity in how these care processes are implemented.