Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

Abstract

Objectives: The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).Methods: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.Results: At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.Conclusions: This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.ACADEMIC EMERGENCY MEDICINE 2015;22:273-284

Der geriatrische Patient in der Notaufnahme

“…Lediglich für einzelne Teilbereiche, wie z. B. Patienten mit kognitiven Einschränkungen, liegen aktuell Struktur und Prozessindikatoren vor [25,26]. Auch das Flaggschiff der externen Qualitätssicherung im Gesundheitswesen in Deutschland, der "Qualitätsreport", welcher mehr als 450 Qualitätsindikatoren aus 31 Leistungsbereichen umfasst, schließt diese Lücke nicht [27,28].…”

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

“…The panel met twice, once in the preliminary stages and again at the conclusion of the field work analysis. Figure 1 gives an overview of the methods used and results developing structural 19 and outcome quality indicators for the care of older ED patients with cognitive impairment. This study (a subset of the primary study) focused on the development of PQIs targeting the special needs of the older ED population with cognitive impairment.…”

“…19 The method developing SQIs for the care of older ED patients with cognitive impairment included a similar approach (literature review, a consultative process engaging experts, and field testing). The field study testing SQIs was carried out in eight emergency departments (i.e., study population) across Australia.…”

“…Improved outcomes may be the result of many factors including, but not limited to, improved processes. Therefore, patient outcomes should also be measured in their own right ( Figure 1 [18][19][20] ).…”

Is Your Department's Quality Good Enough for Your Grandmother? Quality Indicators for Patients With Dementia and Delirium

“…In this issue of Academic Emergency Medicine, Schnitker et al 10,11 succeed in pushing the evidence base further and addressing our understanding of older people's issues. Their two articles empirically and quantitatively evaluate quality care for older patients who present to the ED with cognitive impairment.…”