Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment

Abstract

Background Geriatric adults represent an increasing proportion of emergency department (ED) users, and can be particularly vulnerable to acute illnesses. Health care providers have recently begun to focus upon the development of quality indicators to define a minimal standard of care. Objectives The original objective of this project was to develop additional ED-specific quality indicators for older patients within the domains of medication management, screening and prevention, and functional assessment, but the quantity and quality of evidence was insufficient to justify unequivocal minimal standards of care for these three domains. Accordingly, the authors modified the project objectives to identify key research opportunities within these three domains that can be used to develop quality indicators in the future. Methods Each domain was assigned one or two content experts who created potential quality indicators (QI) based on a systematic review of the literature, supplemented by expert opinion. Candidate quality indicators were then reviewed by four groups: the Society for Academic Emergency Medicine (SAEM) Geriatric Task Force, the SAEM Geriatric Interest Group, and audiences at the 2008 SAEM Annual Meeting and the 2009 American Geriatrics Society Annual Meeting, using anonymous audience response system technology as well as verbal and written feedback. Results High-quality evidence based on patient-oriented outcomes was insufficient or non-existent for all three domains. The participatory audiences did not reach a consensus on any of the proposed QIs. Key research questions for medication management (3), screening and prevention (2), and functional assessment (3) are presented based upon proposed QIs that the majority of participants accepted. Conclusions In assessing a minimal standard of care by which to systematically derive geriatric QIs for medication management, screening and prevention, and functional assessment, compelling clinical research evidence is lacking. Patient-oriented research questions that are essential to justify and characterize future quality indicators within these domains are described.

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

“…11,12 Consequently, geriatric and emergency medicine research opinion leaders list development and implementation trials of prognostic screening instruments among the highest research priorities. 13,14 This systematic review helps define the accuracy of existing screening tools to identify older ED patients at risk of adverse outcomes. Four recent systematic reviews evaluate the content validity and prognostic accuracy of single geriatric screening instruments such as the Triage Risk Screening Tool (TRST), [15][16][17][18] but none of these systematic reviews evaluates all available instruments or all previously described individual risk factors for post-ED adverse outcomes.…”

Der geriatrische Patient in der Notaufnahme

“…Kennzahlen und Qualitätsindikatoren hierfür sind in der internationalen Literatur bislang unterrepräsentiert [22][23][24]. Lediglich für einzelne Teilbereiche, wie z.…”

The development of a European curriculum in Geriatric Emergency Medicine

“…Papers were selected on the basis of their relevance to developing competencies in GEM by agreement between a geriatrician and an emergency physician. A range of articles including North American initiatives to develop a GEM curriculum and recent reviews and key articles in the field were identified and used to inform the development of the domains and items [7][8][9][10][11][12][13][14][15][16][17] . The development focused upon the additional competencies over and above that which would be expected from training in either geriatric medicine or emergency medicine -so this was not simply a reproduction of how to practice emergency medicine in older people, but an attempt to develop higher level competencies that will add value to existing curriculae 7 .…”