This article was reproduced with permission from the authors. Original article from geriatric-ed.com.
Background
Numerous studies have shown that emergency departments (EDs) are less effective in dealing with the complex needs of vulnerable older people. This is due, at least in part, to the failure to provide consistent geriatric screening and senior-friendly care for those at greatest risk of adverse outcomes and progressive decompensation. Complexity and geriatric problems (such as delirium) often remain undetected.
The purpose of the interRAI[1] Emergency Department (ED) Assessment System is to help clinicians consistently identify vulnerability in older patients in order to target senior-friendly care and other geriatric interventions. The system has two companion tools – the ED Screener and the ED Contact Assessment. These tools can be used in isolation or together as two-step (screening and assessment) system.
Screening
Screening, the first step, is done with the ED Screener in about 1 minute by non-specialized staff. The purpose of the ED Screener is to help prioritize patients for senior-friendly care or follow-up by geriatric specialists (e.g., geriatric nursing, social work). It classifies a patient into one of six levels of vulnerability with higher scores indicating a greater need for geriatric assessment and management, where 1 is “Least Urgent” and 6 is “Most Urgent”. The ED Screener score should be noted on the medical record or electronic patient tracking board in order to prioritize geriatric resources (as they exist in your ED). The ED Screener should be done early (often as part of the primary nursing assessment) so that senior-friendly care is not delayed. It is publicly available as a free Apple or Android smartphone or tablet app.
Assessment
Assessment, the second step, is done with the ED Contact Assessment. It is a short and focused geriatric assessment for patients identified as ‘vulnerable’ during geriatric screening. The goal of ED Contact Assessment is to identify and examine individual geriatric syndromes so that they are considered in diagnosis, intervention, and disposition planning. Identifying and acting on geriatric syndromes decreases the probability of error, oversight, as well as delayed or unsuitable discharge. In addition to patient care in the ED, transferring the results of the ED Contact Assessment to post-discharge care providers (inpatient or outpatient) allows them to provide more timely, informed and appropriate follow-up care. The ED Contact Assessment is completed electronically and a summary report of clinical outputs is available immediately to inform care and to communicate with the entire care team. It is completed as soon as appropriate, and is often done by staff with training or interest in geriatrics (e.g., nurses, occupational or physical therapists, social workers) in about 15-20 minutes.
Each ED should adapt their use of the interRAI ED Assessment System according to their unique resources and patient population.
[1] interRAI is a not-for-profit, volunteer only, international network of clinicians and researchers committed to improving health care for persons who are elderly, frail or disabled. Our goal is to promote evidence-based clinical practice and policy decisions through the collection and interpretation of high-quality health information. interRAI instruments were used in over 30 nations, across a wide variety of settings. interRAI licenses its assessment systems without royalties to any government or care provider.
References & Resources
- P. Costa, J Hirdes, S Arino-Blasco, K Berg, V Boscart, C Carpenter, N Curtin-Telegdi, M Emond, L Gray, G Heckman, P Jonsson, M Leyenaar, M Martin-Khan, S Melady, S Sinha, K Singler, F Sjöstrand, W Swoboda, N Wellens, J Morris, M Björkgren, Anja Declercq, H Finne-Soveri, B Fries, M Head, M James, G Ljunggren, T Frise Smith, K Steel, S Stewart, K Szczerbinska, E Topinkova. interRAI Emergency Department (ED) Assessment System Manual, For Use with the interRAI ED Screener (EDS) and ED Contact Assessment (ED-CA) User’s Manual, Forms, and Applications, Open Book Systems, Washington, DC, USA, 2015. ISBN: 978-1-9360-75-22-6.
- Gray, L.C. et al. (2013) Profiles of Older Patients in the Emergency Department: Findings from the interRAI Multinational Emergency Department Study. Annals of Emergency Medicine, 62(5): 467-74.
- Costa, A.P et al. (2014) Geriatric Syndromes Predict Post-Discharge Outcomes among Older Emergency Department Patients: Findings from the interRAI Multinational Emergency Department Study. Academic Emergency Medicine, 21(4): 422-433.