A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

被引:49
作者
Hogan, Teresita M. [1 ]
Olade, Tolulope Oyeyemi [2 ]
Carpenter, Christopher R. [3 ]
机构
[1] Univ Chicago, Sch Med, Dept Med, Sect Emergency Med, Chicago, IL 60637 USA
[2] Univ Chicago, Chicago, IL 60637 USA
[3] Washington Univ, Sch Med, Div Emergency Med, St Louis, MO 63130 USA
关键词
OLDER-ADULTS; MEDICAL-EDUCATION; ELDERLY EMERGENCY; HEALTH OUTCOMES; MENTAL STATUS; RISK-FACTORS; INTERVENTION; MULTICENTER; MANAGEMENT; PATTERNS;
D O I
10.1111/acem.12332
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundThe aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States. ObjectivesThe primary objective was to determine the number, distribution, and characteristics of geriatric EDs in the United States in 2013. MethodsThis was a survey with potential respondents identified via a snowball sampling of known geriatric EDs, EM professional organizations' geriatric interest groups, and a structured search of the Internet using multiple search engines. Sites were contacted by telephone, and those confirming geriatric EDs presence received the survey via e-mail. Category questions included date of opening, location, volumes, staffing, physical plant changes, screening tools, policies, and protocols. Categories were reported based on general interest to those seeking to understand components of a geriatric ED. ResultsThirty-six hospitals confirmed geriatric ED existence and received surveys. Thirty (83%) responded to the survey and confirmed presence or plans for geriatric EDs: 24 (80%) had existing geriatric EDs, and six (20%) were planning to open geriatric EDs by 2014. The majority of geriatric EDs are located in the Midwest (46%) and Northeast (30%) regions of the United States. Eighty percent serve from 5,000 to 20,000 elder patients annually. Seventy percent of geriatric EDs are attached to the main ED, and 66% have from one to 10 geriatric beds. Physical plant changes include modifications to beds (96%), lighting (90%), flooring (83%), visual aids (73%), and sound level (70%). Seventy-seven percent have staff overlapping with the nongeriatric portion of their ED, and 80% require geriatric staff didactics. Sixty-seven percent of geriatric EDs report discharge planning for geriatric ED patients, and 90% of geriatric EDs had direct follow-up through patient callbacks. ConclusionsThe snowball sample identification of U.S. geriatric EDs resulted in 30 confirmed respondents. There is significant variation in the components constituting a geriatric ED. The United States should consider external validation of self-identified geriatric EDs to standardize the quality and type of care patients can expect from an institution with an identified geriatric ED. Resumen IntroduccionEl envejecimiento de Estados Unidos plantea una oportunidad para los servicios de urgencias (SU). Los estudios muestran que los pacientes ancianos tienen peores resultados a pesar de un mayor numero de pruebas diagnosticas, periodos de observacion prolongados y mayores porcentajes de ingreso. En respuesta, las maximas autoridades de la Medicina de Urgencias y Emergencias (MUE) han implementado estrategias para mejorar la atencion del paciente anciano en los SU, mediante un incremento de los expertos, el equipamiento, las politicas y los protocolos. Un ejemplo es el desarrollo de SU geriatricos que ganan en popularidad en toda la nacion. Segun el conocimiento de los autores, esta es la primera revision que identifica de forma sistematica y caracteriza cualitativamente la existencia, la localizacion y las caracteristicas de los SU geriatricos en Estados Unidos. ObjetivosEl objetivo principal fue determinar el numero, la distribucion y las caracteristicas de los SU geriatricos en Estados Unidos en 2013. MetodologiaSe realizo una encuesta cuyos potenciales respondedores se identificaron mediante un muestreo de bola de nieve de los SU geriatricos conocidos, los grupos de interes geriatricos de las organizaciones profesionales de MUE y una busqueda estructurada en internet mediante multiples motores de busqueda. Se contacto con los lugares mediante una llamada telefonica, y aquellos que confirmaron la presencia de SU geriatricos recibieron la encuesta via correo electronico. Las preguntas categorizadas incluyeron fecha de apertura, localizacion, volumenes, personal, cambios fisicos de la planta, herramientas de despistaje, politicas y protocolos. Las categorias se documentaron en base a un interes general de aquellos que buscaban comprender los componentes de un SU geriatrico. ResultadosTreinta y seis hospitales confirmaron la existencia de un SU geriatrico y recibieron la encuesta. Treinta (80%) respondieron la encuesta y confirmaron la presencia de planes para el SU geriatrico: 24 (80%) tenian un SU geriatrico y seis (20%) estaban planeando abrirlo en 2014. La mayoria de los SU geriatricos estan localizados en las regiones del medioeste (46%) y noreste (30%) de Estados Unidos. El 80% atiende de 5.000 a 20.000 ancianos anualmente; el 70% esta junto al SU principal; y el 66% tiene de una a diez camas geriatricas. Los cambios fisicos de la planta incluyen modificacion de las camas (96%), iluminacion (90%), suelos (83%) y recursos visuales (73%) y nivel de sonido (70%). El 77% tiene profesionales sanitarios entremezclados con una parte no geriatrica de su SU, y el 80% necesita personal geriatrico formado. EL 77% documento planes de alta para los pacientes del SU geriatrico y un 90% tuvo seguimiento directo a traves de llamadas a los pacientes. ConclusionesLa identificacion de los SU geriatricos a traves de una muestra de bola de nieve resulto en 30 respuestas confirmatorias. Existe una variacion significativa en los componentes que constituyen los SU geriatricos. Estados Unidos deberia considerar una validacion externa de los SU geriatricos propiamente identificados para estandarizar la calidad y el tipo de atencion que los pacientes pueden esperar de una institucion con un SU geriatrico identificado.
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页码:337 / 346
页数:10
相关论文
共 91 条
[1]   A new model for emergency care of geriatric patients [J].
Adams, JG ;
Lowell, WG .
ACADEMIC EMERGENCY MEDICINE, 2003, 10 (03) :271-274
[2]  
Adams R, 2002, STROKE, V33, P326
[3]  
Agency for Healthcare Research and Quality, 2012, EM SEV IND ESI IMPL
[4]  
Amini R., 2012, EMERGEN MED, V2, pe110
[5]   Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions [J].
Aminzadeh, F ;
Dalziel, WB .
ANNALS OF EMERGENCY MEDICINE, 2002, 39 (03) :238-247
[6]  
[Anonymous], 2012, ED Manag, V24, P127
[7]  
[Anonymous], 2008, LANCET, V371, P959, DOI 10.1016/S0140-6736(08)60425-0
[8]   Quality care for older people with urgent and emergency care needs in UK emergency departments [J].
Banerjee, Jay ;
Conroy, Simon ;
Cooke, Matthew W. .
EMERGENCY MEDICINE JOURNAL, 2013, 30 (09) :699-700
[9]   PERCEPTIONS OF EMERGENCY CARE BY THE ELDERLY - RESULTS OF MULTICENTER FOCUS GROUP INTERVIEWS [J].
BARAFF, LJ ;
BERNSTEIN, E ;
BRADLEY, K ;
FRANKEN, C ;
GERSON, LW ;
HANNEGAN, SR ;
KOBER, KS ;
LEE, S ;
MAROTTA, M ;
WOLFSON, AB .
ANNALS OF EMERGENCY MEDICINE, 1992, 21 (07) :814-818
[10]   Primary care - Will it survive? [J].
Bodenheimer, Thomas .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (09) :861-864