Evaluation of a screening program for older adults visiting the Emergency Department

Acute presentation to the emergency department (ED) of older patients associates with a high chance of poor outcome and poses great challenges to the healthcare system. Early identification in the ED of older patients at highest risk of various poor outcomes may contribute to the prevention of these adverse events and may lead to more efficient ED care.

Recently, we have therefore developed and validated the APOP screener for early identification of older patients at high risk for functional decline, mortality and cognitive impairment. A positive screening will result in follow-up interventions, as part of the screening program for older patients visiting the ED. The screening program will be implemented in everyday clinical practice as a part of standard care. Successful implementation generally requires a comprehensive approach, in which adherence and effectiveness on process of care indicators and patient outcomes are investigated. In this study we will evaluate the success of implementation of the APOP screening program for older patients in the emergency department.

Early identification of and specific interventions for older ED patients at highest risk of various poor outcomes contribute to the prevention of adverse events and lead to more efficient ED care.

-Patient inclusion during before period: 1-12-2017 till 1-2-2018

-Implementation period: education month 1-2-2018 till 1-3-2018 and start with APOP screening program on 1-3-2018

-Patient inclusion during after period: 1-4-2018-1-6-2018

Implementation of the APOP screening program in routine ED care. The program consists of 4 parts:

1. The APOP-screener to identify individual risk of functional decline and/or mortality in the next 3 months and signs of impaired cognition on the ED.

2. Interventions for patients with high risk on one or both domains. The awareness generated by screening can lead to better shared decision making and more efficient care on the ED for high risk patients. For patients with signs of impaired cognition we can reduce negative effects of an ED stay by starting delirium prevention on the ED. Patients with a high change of admission can be admitted with a fast-track to reduce negative effects of an ED stay and to improve patient flow.

3. Transition of care and screening results to the following caregivers. After admission all high risk patients will receive a comprehensive geriatric assessment on the admitting ward thru geriatric consultation. The high risk patients discharged home will receive better (written) discharge instructions and telephone follow-up in 24hours by an ED-nurse. The high risk results and follow-up advises will be communicated with the patients general practitioner.

4. Development and delivery of an education program on geriatric emergency medicine to health care professionals working on the ED and admitting wards.