Quality indicators for a geriatric emergency care (GeriQ-ED) – an evidence-based delphi consensus approach to improve the care of geriatric patients in the emergency department

Abstract

Introduction: In emergency care, geriatric requirements and risks are often not taken sufficiently into account. In addition, there are neither evidence-based recommendations nor scientifically developed quality indicators (QI) for geriatric emergency care in German emergency departments. As part of the GeriQ-ED© research project, quality indicators for geriatric emergency medicine in Germany have been developed using the QUALIFY-instruments. Methods: Using a triangulation methodology, a) clinical experience-based quality aspects were identified and verified, b) research-based quality statements were formulated and assessed for relevance, and c) preliminary quality indicators were operationalized and evaluated in order to recommend a feasible set of final quality indicators. Results: Initially, 41 quality statements were identified and assessed as relevant. Sixty-seven QI (33 process, 29 structure and 5 outcome indicators) were extrapolated and operationalised. In order to facilitate implementation into daily practice, the following five quality statements were defined as the GeriQ-ED© TOP 5: screening for delirium, taking a full medications history including an assessment of the indications, education of geriatric knowledge and skills to emergency staff, screening for patients with geriatric needs, and identification of patients with risk of falls/ recurrent falls. Discussion: QIs are regarded as gold standard to measure, benchmark and improve emergency care. GeriQ-ED© QI focused on clinical experience-and research-based recommendations and describe for the first time a standard for geriatric emergency care in Germany. GeriQ-ED© TOP 5 should be implemented as a minimum standard in geriatric emergency care.

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine

“…Geriatric Emergency Medicine guidelines have been developed in the USA [15]. Also, several sets of quality indicators have been published in the USA [16,17], UK [18] and Germany [19], as well as text books that have been written on this topic [20,21]. Furthermore, specific guidelines and reviews on typical geriatric syndromes and problems for the ED have emerged [22][23][24].…”

Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

“…In future, we aim to focus more on physicians and use additional education to increase their awareness and promote a more holistic clinical assessment of older ED patients. Moreover, the interventions of our program were based on recommendations from international guidelines and quality indicators [ 6 , 20 ] and could be updated according to recent recommendations [ 30 ]. If other EDs would like to implement a screening program for older patients they can learn from our limitations and adjust their expectations accordingly, i.e.…”

Prevalence and pattern of geriatric emergencies in a teaching hospital of North India

“…Thus, quality indicator projects should be taken up to upgrade the existing system of health care. [ 27 ]…”