McDonald, T. A., 2008
ISQua Conference, Copenhagen, Denmark.
Background: The NSW Public Hospital system has concerns that the environment in emergency departments may impede access by older adults and the efficacy of treatment. Policy makers were interested in mapping the experiences of this patient cohort across several years using historical records.
Objective: To examine whether the presence of an aged services team (ASET) in the emergency department (ED) reduces avoidable admissions and waiting times for older people; and affects the quality of older people’s ED experience; and to examine clinician awareness of older people’s care needs.
To examine whether the presence of an ASET in ER influences:
Methods: Data was gathered from two primary sources: (1) ED attendee data for 2003 and 2004 entered into the Emergency Department information system (EDIS); and (2) Face-to-face interviews with 30 of the 36 ASET teams across the State.
The EDIS data for both years was analysed to reveal patterns related to referral sources; outcomes of ED attendances; waiting times and client throughput. Interview data was thematically analysed to reveal views held on the quality of older people’s ED experiences; clinician awareness of older people’s needs; and relationships with other teams and stakeholders.
Results: A total of 352,942 cases in 2003 and 438596 in 2006 were analysed in relation to primary diagnosis groups, referral sources and ED outcomes (admission, discharge, died or unknown). Discharges of attendees aged 55-79 years increased for 2006 while for those aged 80+ years the reverse occurs. Differences between the 2003 and 2006 data indicate that the presence of ASET within the ED has contributed to a heightened awareness by clinicians of older people’s needs, the benefits of comprehensive health and social assessment, the importance of safe discharges for this group, and the need to advocate for admission where necessary. Each of the objectives was addressed however some results were not able to be conclusively attributed to ASET who work as part of the ER team. Still, review recommendations have begun to be implemented and increased resources have been allocated to the ASET strategy.
Conclusions: There is evidence that ASET services enhance the quality and safety of ED services to older attendees and especially those aged 80+ years. Issues such as waiting times and assessment leading to diagnosis and treatment highlight the need for efficient screening for ASET referral; diligent documentation of details such as referral sources and outcomes of ED care; and ongoing education of ED clinicians about the effects on frail older people of hospital attendances.
CITATION McDonald T. (2008) Age-friendly practices in emergency departments (ED) generating benefits for all involved. The International Society for Quality in Health Care (ISQua) 25th International Conference in Copenhagen from 19 to 22 October.
NOTE McDonald, T. (2008) Review of Aged Care Services in Emergency Teams (ASET) in NSW Public Hospitals. Report: NSW Department of Health, Sydney Australia.