&lt;p&gt;Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria&lt;/p&gt;

Fernandez, Forrest B.; Ong, Adrian W.; Martin, Anthony; Schwab, C. William; Wasser, Tom; Butts, Christopher A.; McNicholas, Amanda; Müller, Alison; Barbera, Charles; Trupp, Rachael; Sigal, Adam

doi:10.2147/oaem.s212617

Cited by 11 publications

(4 citation statements)

References 23 publications

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“…12 32 42 A recent study demonstrated that a specialised protocol to triage older persons in the ED significantly reduces time to physician assessment, as well as overall ED length of stay. 47 This is further supported in other research that suggests triage processes may not address the special care needs of older persons in the ED. 48 Further investigation into these types of interventions could support changes in practice guidelines and the development of new quality measures, such as a structural measure for the presence of a geriatric triage protocol.…”

Section: Discussionmentioning

confidence: 65%

“…Issues meeting timeliness scores may point to larger systemic issues related to availability of ambulances, staff, ED beds or issues of ageism 12 32 42. A recent study demonstrated that a specialised protocol to triage older persons in the ED significantly reduces time to physician assessment, as well as overall ED length of stay 47. This is further supported in other research that suggests triage processes may not address the special care needs of older persons in the ED 48.…”

Section: Discussionmentioning

confidence: 93%

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Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

et al. 2022

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BackgroundLong-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset.MethodsIn the Older Persons’ Transitions in Care (OPTIC) study, we collected information on residents’ transitions in two Western Canadian cities. We applied the IOM’s Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality.ResultsWe tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to develop measures for equitable care at an individual transfer level. Domain scores varied across individual transitions, with the highest scores in safety (MED 79%, IQR: 63–95), efficiency (66%; IQR: 66–99), and resident-centred (45%; IQR: 25–65), followed by effectiveness (36%; IQR: 16–56), and timeliness (0%; IQR: 0–50).ConclusionsOur results show variation in scores across the domains of quality suggesting that it is possible to track quality of transitions for individuals across all settings, and not only within settings. We recommend that future work in tracking quality of care be performed at several levels (LTC, region, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 93%

Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

et al. 2022

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“…Patient outcomes including mortality and morbidity were measured and system performance indicators such as the number of patients included in trauma activation, time to be seen, time to treatment, LOS and patient disposition, were collected. Widening capture of older patients increased existing trauma team workload, but did not always result in better outcomes [ 99 , 102 , 104 ], whereas introduction of a third-tier trauma protocol reduced ED LOS (5.5 h pre vs 4.5 h post; p < 0.01), decreased hospital admissions (98.4% pre vs 61.9% post), and lowered complication rates (16.4% pre vs 1.6% post; p < 0.01) in one study [ 100 ]. However, hospital LOS increased (4.4 days pre vs 4.8 days post; p = 0.02), as did mortality (1.6% pre vs 4.8% post).…”

Section: Resultsmentioning

confidence: 99%

Strategies to improve care for older adults who present to the emergency department: a systematic review

Testa,

Richardson,

Cheek

et al. 2024

BMC Health Serv Res

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Background The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. Methods A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. Results Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. Conclusion It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication.

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“…Efforts have been made elsewhere to address patients > 65 years of age with low--energy falls, with expedited teams specifically addressed for this group. One study found to decrease length of stay, but with no improvement in mortality after implementing an expedited team [ 17 ]. If we are to provide a decent and optimal care for older patients with low injury falls, a change in the trauma system may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

Thorsen

Narvestad

Tjosevik

et al. 2021

Eur J Trauma Emerg Surg

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Background The aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality. Material and methods A before–after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017–2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality. Results During the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15). Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8–4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28–0.96) Conclusion A protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.

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<p>Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria</p>

Cited by 11 publications

References 23 publications

Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

Strategies to improve care for older adults who present to the emergency department: a systematic review

Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

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