Article

Transitions of Care for the Geriatric Patient in the Emergency Department

Department of Emergency Medicine, Combined Internal Medicine/Emergency, Medicine Residency, University of Illinois-Chicago, 1700 West Taylor, Chicago, IL 60612, USA
Clinics in Geriatric Medicine (Impact Factor: 3.19). 02/2013; 29(1):49-69. DOI: 10.1016/j.cger.2012.10.005
Source: PubMed

ABSTRACT

This article reviews and summarizes more than 200 studies regarding key issues surrounding the transition of elderly patients to or from the emergency department (ED), with particular attention paid to the relationship between the ED and nursing homes. Transfers of care often occur with incomplete information, which results in increased morbidity, recidivism, and cost. Transitions of elderly patients could be improved by standardizing hand-offs processes, improving discharge planning for elderly patients, developing metrics for transfers of care and geriatric care quality, and finding sustainable sources of research funding.

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    • "ED staff depend on medical, functional and social information being communicated to them to provide appropriate person-centred care (Salinas & Ramakrishnan 2012). However, international studies have identified deficits in communication between aged care facilities and EDs (Terrell et al. 2005, Cwinn et al. 2009, Dalawari et al. 2011, Platts-Mills et al. 2012, Kessler et al. 2013, Morphet et al. 2014). Relatives are frequently an important source of information for ED staff, providing the medical history and assisting with treatment decisions for older people. "
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    ABSTRACT: The aim of this study was to investigate the experiences of relatives who had a family member in an aged care facility subsequently transferred to an emergency department. The provision of timely and relevant patient information is vital for assessment and management of older patients presenting to the emergency department from aged care facilities. Older people are commonly accompanied by relatives who are an important resource for emergency department staff, providing medical information and assisting with treatment decisions. Investigating the experiences of relatives may provide key information to enable improvements in the delivery of emergency department care. This study used a descriptive qualitative design. Semi-structured interviews were undertaken with 24 relatives of residents who were transferred from an aged care facility to an emergency department in Victoria, Australia in the previous three years. Inductive content analysis was used to analyse the transcripts. Relatives reflected on four main themes following their emergency department visit: The need for clear communication; The role of relatives in emergency department care; How older people are perceived in the health care system and an Ability to provide specialised care. Many people link their emergency department experience to the quality of communication with emergency department staff, and participants in this study felt satisfied with their visit when they were included in discussions about treatment, and their role was recognised by staff members. In contrast, participants were dissatisfied with the care provided to their family member when staff members failed to communicate with them, or recognise their role in the care of the family member. The findings of this study emphasise the importance of effective communication between emergency department staff and family members, in relation to treatment and end-of-life care. © 2015 John Wiley & Sons Ltd.
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    ABSTRACT: This study exposes a gap in patient safety that reflects challenges in information exchange and cross-setting communication. Research staff at the Muskie School of Public Service, with funding from the Agency for Healthcare Research and Quality, developed a demonstration project to document and standardize critical communication pathways and information between the nursing facilities (NF), emergency medical services (EMS), and emergency departments (ED) to reduce medication errors, delays in treatment, infections, and missing or misunderstood patient directives and consent.
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