Quality Indicators for Geriatric Emergency Care

Terrell, Kevin M.; Hustey, Fredric M.; Hwang, Ula; Gerson, Lowell W.; Wenger, Neil S.; Miller, Douglas K.

doi:10.1111/j.1553-2712.2009.00382.x

Cited by 161 publications

(123 citation statements)

References 74 publications

(120 reference statements)

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“…Following the review of the literature the research team reported 19 draft PQIs prepared for consideration by the advisory panel at the first meeting, including six published PQIs established for the care of older ED patients by the Society for Academic Emergency Medicine (SAEM)'s Geriatric Task Force 26 and four PQIs selected from the ACOVE indicators aimed at older persons who are at risk of serious declines in health. [27][28][29] All 19 were considered as potentially usable for the care process evaluation by the advisory panel.…”

Section: Resultsmentioning

confidence: 99%

“…The following section presents the PQIs and associated field data and advisory panel deliberations. 26 This PQI stated that, "IF an older adult presents to an ED, THEN the ED provider should carry out and document a cognitive assessment (such as an indication of level of alertness and orientation, or an indication of abnormal or intact cognitive status) or document why a cognitive assessment did not occur." 26 The focus is on older people receiving cognitive assessments during their ED episodes of care.…”

Section: Resultsmentioning

confidence: 99%

“…26 This PQI stated that, "IF an older adult presents to an ED, THEN the ED provider should carry out and document a cognitive assessment (such as an indication of level of alertness and orientation, or an indication of abnormal or intact cognitive status) or document why a cognitive assessment did not occur." 26 The focus is on older people receiving cognitive assessments during their ED episodes of care. Our panel supported cognitive screening (as an alternative to assessment), as cognitive screening evaluates the possible presence of cognitive impairment.…”

Section: Resultsmentioning

confidence: 99%

“…The drafted PQIs were divided into two sets: those relevant to all older persons but with a cognition focus (i.e., cognitive screening) and those particularly relevant to people identified as having cognitive impairment (such as management of behaviors for older people with dementia). The existing indicators (previously published [26][27][28][29] ), which were scored in their published format, and the PQIs drafted by the advisory panel, were subsequently field tested in phase 2. For published quality indicators where there was no scoring or definition information publically available, the research team developed a formal scoring methodology.…”

Section: Outcome Quality Indicatorsmentioning

confidence: 99%

“…As a starting point, we identified any published quality indicators for similar populations. A review of the literature identified PQIs for geriatric emergency care 26 that were specifically designed for older ED patients and Assessing Care of Vulnerable Elders (ACOVE) indicators, which were intended to improve the care for vulnerable elders in the community. [27][28][29][30] These existing PQIs may be relevant for the older ED population with cognitive impairment.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Process Quality Indicators Targeting Cognitive Impairment to Support Quality of Care for Older People with Cognitive Impairment in Emergency Departments

Schnitker

Martin‐Khan

Burkett

et al. 2015

Academic Emergency Medicine

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Objectives: The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED).Methods: A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation.Results: In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay.Conclusions: This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions

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