An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines

Southerland, Lauren T.; Vargas, Anthony J.; Nagaraj, Lalitha; Gure, Tanya R.; Caterino, J.M.

doi:10.1111/acem.13328

Cited by 34 publications

(46 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some EDs currently employ pharmacists and PTs to evaluate geriatric patients once the individual is moved to an ED observation unit. A recent retrospective study of 221 older patients evaluated in an ED observation unit by a multidisciplinary team including pharmacists, PTs, case managers, and geriatricians had a mean LOS of 12.2 (±5) hours and a hospital admission rate of 41.7% . Subsequent healthcare utilization and falls were not reported.…”

Section: Discussionmentioning

confidence: 99%

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Goldberg

Marks

Ilegbusi

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single‐blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019

show abstract

Section: Discussionmentioning

confidence: 99%

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Goldberg

Marks

Ilegbusi

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…In the ED, the Aged Services Emergency Team nurses or multi‐disciplinary team members can perform some of these evaluations. Short stay observation unit admissions are commonly used to facilitate this evaluation: providing access to multi‐disciplinary teams and a clearer plan for safe transition to home …”

Section: Evaluating Falls In the Edmentioning

confidence: 99%

“…Acknowledging ED time, space, and personnel constraints, the primary focus after injury management for older fallers being discharged home should be to initiate the process of screening fall risk with immediate interventions for amenable risk factors (de‐prescribing high‐risk medications) and referral to the general practitioner for more detailed assessment and management. ED care coordination teams, often involving allied health professionals, are one approach to implement this multi‐disciplinary strategy …”

Section: Preventing Subsequent Fallsmentioning

confidence: 99%

“…Short stay observation unit admissions are commonly used to facilitate this evaluation: providing access to multidisciplinary teams and a clearer plan for safe transition to home. 29 Falls are generally multifactorial, but can be associated with specific acute or chronic medical issues (Table 3). 22 The term 'mechanical fall' has no place as an explanation for ED presentation.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…ED care coordination teams, often involving allied health professionals, are one approach to implement this multidisciplinary strategy. 29…”

Section: Preventing Subsequent Fallsmentioning

confidence: 99%

See 2 more Smart Citations

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

Nagaraj

Hullick

Arendts

et al. 2018

Emerg Medicine Australasia

View full text Add to dashboard Cite

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions

et al. 2020

View full text Add to dashboard Cite

Background A significant number of patients who present to the emergency department (ED) following a fall or with other injuries require evaluation by a physical therapist. Traditionally, once emergent conditions are excluded in the ED, these patients are admitted to the hospital for evaluation by a physical therapist to determine whether they should be transferred to a sub‐acute rehabilitation facility, discharged, require services at home, or require further inpatient care. Case management is typically used in conjunction with a physical therapist to determine eligibility for recommended services and to aid in placement. Objective To evaluate the benefit of using ED‐based physical therapist and case management services in lieu of routine hospital admission. Methods Retrospective, observational study of consecutive patients presenting to an urban, tertiary care academic medical center ED between December 1, 2017, and November 30, 2018, who had a physical therapist consult placed in the ED. We additionally evaluated which of these patients were placed into ED observation for physical therapist consultation, how many required case management, and ED disposition: discharged home from the ED or ED observation with or without services, placed in a rehabilitation facility, or admitted to the hospital. Results During the 12‐month study period, 1296 patients (2.4% of the total seen in the ED) were assessed by a physical therapist. The mean age was 75.5 ± 15.2 and 832 (64.2%) were female. Case management was involved in 91.8% of these cases. The final patient disposition was as follows: admission 24.3% (95% CI = 22.1–26.7%), home discharge with or without services 47.8% (95% CI = 45.1–50.5%), rehabilitation (rehab) setting 27.9% (95% CI = 25.6%–30.4). The median (interquartile range) time in observation was 13.1 (6.0–20.3), 9.9 (1.8–15.8), and 18.4 (14.1–24.8) hours for patients admitted, discharged home, or sent to rehabilitation ( P < 0.001). Among the 979 patients discharged home or sent to rehabilitation, 17 (1.7%) returned to the ED within 72 hours and were ultimately admitted. Conclusion Given that the standard of care would otherwise be an admission to the hospital for 1 day or more for all patients requiring physical therapist consultation, an ED‐based physical therapy and case management system serves as a viable method to substantially decrease hospital admissions and potentially reduce resource use, length of hospital stay, and cost both to patients and the health care system.

show abstract

An Emergency Department Observation Unit Is a Feasible Setting for Multidisciplinary Geriatric Assessments in Compliance With the Geriatric Emergency Department Guidelines

Abstract: Background: The Geriatric Emergency Department (ED) Guidelines recommend providing multidisciplinary

Cited by 34 publications

References 18 publications

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

The utility of emergency department physical therapy and case management consultation in reducing hospital admissions

Contact Info

Product

Resources

About