Identifying frailty in the Emergency Department—feasibility study

Elliott, Amy J.; Phelps, Kay; Regen, Emma; Conroy, Simon

doi:10.1093/ageing/afx089

Cited by 81 publications

(106 citation statements)

References 14 publications

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“…Time to complete screening is an important determinant of feasibility and acceptability [ 1 , 21 ]. The 2-minute time to complete the APOP screener could therefore be an important facilitator of screening completion [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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Background risk stratification tools for older patients in the emergency department (ED) have rarely been implemented successfully in routine care. Objective to evaluate the feasibility and acceptability of the ‘Acutely Presenting Older Patient’ (APOP) screener, which identifies older ED patients at the highest risk of adverse outcomes within 2 minutes at presentation. Design and setting 2-month prospective cohort study, after the implementation of the APOP screener in ED routine care in the Leiden University Medical Center. Subjects all consecutive ED patients aged ≥70 years. Methods feasibility of screening was assessed by measuring the screening rate and by identifying patient- and organisation-related determinants of screening completion. Acceptability was assessed by collecting experienced barriers of screening completion from triage-nurses. Results we included 953 patients with a median age of 77 (IQR 72–82) years, of which 560 (59%) patients were screened. Patients had a higher probability of being screened when they had a higher age (OR 1.03 (95%CI 1.01–1.06), P = 0.017). Patients had a lower probability of being screened when they were triaged very urgent (OR 0.55 (0.39–0.78), P = 0.001) or when the number of patients upon arrival was high (OR 0.63 (0.47–0.86), P = 0.003). Experienced barriers of screening completion were patient-related (‘patient was too sick’), organisation-related (‘ED was too busy’) and personnel-related (‘forgot to complete screening’). Conclusion with more than half of all older patients screened, feasibility and acceptability of screening in routine ED care is very promising. To further improve screening completion, solutions are needed for patients who present with high urgency and during ED rush hours.

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Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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“…a tool, rule or standardized testing) found them to improve diagnostic accuracy and reduce uncertainty. However, an almost similarly large percentage found no difference (37,43,56,57) or a decline in performance (58)(59)(60)(61).…”

Section: Effects Of Aidsmentioning

confidence: 92%

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Gamborg

Mehlsen

Paltved

et al. 2020

Preprint

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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“…These are of variable length and complexity and might use a patient self‐answer questionnaire, interview, observed physical performance or any combination of these. ED researchers across the world already use instruments to identify vulnerable older adults at risk of short‐term adverse events following an episode of ED care . Unfortunately, none of the current constructs of frailty or individual patient predictors, like age >85 or functional dependence, alone sufficiently discriminate high‐ and low‐risk subsets .…”

Section: Can Frailty Be Easily Diagnosed and Managed?mentioning

confidence: 99%

Frailty, thy name is…

Arendts

Burkett

Hullick

et al. 2017

Emerg Medicine Australasia

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Identifying frailty in the Emergency Department—feasibility study

Abstract: validated risk stratification tools are quick, simple, easy to use and 75% of staff would use the tools again in the future.

Cited by 81 publications

References 14 publications

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

Frailty, thy name is…

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