OBJECTIVES: To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults.
DESIGN: A conceptual model informed, protocol-based systematic review.
SETTING: Emergency Department (ED).
PARTICIPANTS: Older adults 65 years of age and older.
METHODS AND MEASUREMENT: Medline, Embase, CINAHL, and PsycINFO were searched for English-language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi-strategy) and key intervention components present (ie, assessment, referral plus follow-up, and contact both before and after ED discharge ["bridge"]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated.
RESULTS: A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit.
CONCLUSION: Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.
The results of this systematic review are inconclusive and more research will be needed for interventions that may guide practice to emerge.
Although this is a relevant topic, the review provided very little conclusions and raised many more questions regarding effect of ED interventions.
As an emergency nurse and clinical nurse educator in an "adult" emergency department, I find the majority of our patients are elderly. This appears to be a good review. Methodologically, it looks reasonably well done. The use of GRADE methods is a strength. The key implications are especially useful, though "comprehensive assessment" and "bridge care" are largely self evidence suggestions.
As a geriatric emergency nurse, I believe this article provides evidence for outcomes of interventions in geriatric emergency patients. I can use this evidence in planning interventions and outcome measuring for research.
Results were not surprising and speak to the need for further research on management of the elderly patient in our health care system.
This summary is probably mainly useful in that it highlights a question that still requires further thought and study. Many of our older, frailer patients need a more thorough, but at the same time, efficient way of managing their presentations in a busy setting that is quite often not geared up for what they need. More work is needed.
Interesting article; although, it's not critical for most ed physicians!