scholarly journals 28 Can Comprehensive Geriatric Assessment be Achieved in the Emergency Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Cheng ◽  
C Ho ◽  
K Honney ◽  
M Wells ◽  
W Wise ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Average Length ◽  
University Hospital ◽  
Emergency Setting ◽  
Care Plans ◽  
Average Length Of Stay ◽  
Standard Tool ◽  
The Uk

Abstract Background Our National Health Service is facing unprecedented challenges to accommodate our frailer healthcare users. The gold standard tool for the identification and management of frailty is the Comprehensive Geriatric Assessment (CGA) and has been shown to lead to better outcomes in terms of morbidity and mortality. Introduction With a largely elderly demographic profile in the East of England, the Norfolk and Norwich University Hospital opened the first Older People’s Emergency Department (OPED) in the UK in 2017. This work reviews the effectiveness of a geriatrician-led CGA in a dedicated OPED, which operates during daylight hours, compared to usual care in Accident & Emergency (A&E). Methods 99 patients assessed in OPED and 99 patients assessed overnight in A&E during February 2019 were included in this retrospective study. Electronic case notes for each patient were reviewed by the authors and results were expressed as percentages. Results OPED outperformed A&E in all components of the CGA; strongest areas included assessing for pain, falls risk and activities of daily living. Both departments performed well in reviewing medications and assessing for safeguarding concerns. Areas for improvement include assessing for mood disorders, sensory impairment, discussing Do Not Attempt Cardiopulmonary Resuscitation status, and end of life care plans. The average length of stay of OPED patients was only 7.3 days compared to 8.7 days in A&E, and 89% of OPED patients were discharged back to their usual residences compared to 87% in A&E. Conclusions The improved CGA process in OPED has led to better outcomes, notably through a reduction in the average length of inpatient stay. Nevertheless, certain components of the CGA still require improvement. Further examination is needed to assess long-term mortality to support the use of CGA in the emergency setting.

scholarly journals Characteristics of patients hospitalised in an emergency department observation unit in Japan

2018 ◽  
Vol 14 (2) ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Yuhei Ohtaki ◽  
Nobuaki Kiriyama ◽  
Kei Ohtani ◽  
Wataru Yajima ◽  
...  
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Emergency Departments ◽  
Average Length ◽  
Developed Countries ◽  
The United States ◽  
University Hospital ◽  
Medical Systems ◽  
Average Length Of Stay ◽  
Emergency Medical Systems

In Japan, transporting elderly patients to emergency departments has recently posed serious problems, including a longer average time from patients’ initial emergency calls to their arrival at hospitals. To manage emergency departments more efficiently, many hospitals in the United States and some other developed countries, including Japan, introduced emergency department observation units (EDOU). However, because the usefulness of EDOUs in managing elderly patients remains uncertain, we analysed data of patients admitted to a Japanese university hospital’s EDOU to gauge its efficacy. We followed 1,426 patients admitted to the hospital’s EDOU from 1 January 2011 to 31 December 2014. The average age of patients who stayed in the EDOU increased, whereas the average length of time that they spent there decreased. Although the percentage of patients older than 65 years increased slightly, from 36.42% (2011–2012) to 37.73% (2013–2014), the proportion of those patients between the two periods did not significantly change (P = .61). Moreover, their average length of stay was 2.16 ± 0.91 days, whereas patients younger than 65 years stayed for significantly less time (1.92 ± 0.82 days). By condition, approximately 36% of patients older than 65 years presented with non-neurosurgical trauma, approximately 59% presented with other forms of trauma, but proportions of both categories of trauma were significantly smaller in patients younger than 65 years (nonneurosurgical trauma, 23%; all trauma, 47%). Most elderly patients with limb trauma prepped for surgery were transferred to other hospitals after a few days. Results suggest that the EDOU at the university hospital has served to as a buffer for regional emergency medical systems in Japan, especially given the continued ageing of the Japanese population.

scholarly journals Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions

2014 ◽  
Vol 52 (195) ◽  
pp. 878-885 ◽  
Author(s):  
Oya Durmus Cakir ◽  
Sebnem Eren Cevik ◽  
Mehtap Bulut ◽  
Ozlem Guneyses ◽  
Sule Akkose Aydin
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Waiting Times ◽  
Pediatric Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Average Length Of Stay ◽  
Bed Capacity

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.  Keywords: bed capacity; crowding; emergency department; length of stay.  

scholarly journals Emergency Surgery in A Tertiary Hospital: The Covid-19 Experience

2020 ◽  
Author(s):  
Gennaro Perrone ◽  
Mario Giuffrida ◽  
Elena Bonati ◽  
Paolo Del Rio ◽  
Vittoria Pattonieri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Acute Appendicitis ◽  
Acute Cholecystitis ◽  
Emergency Surgery ◽  
Average Length ◽  
Medical Science ◽  
University Hospital ◽  
Average Length Of Stay ◽  
The Impact

Objective: Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in an Emergency Department of a tertiary COVID-Hospital. Methods: We reported and compared the surgical procedures performed for acute appendicitis and acute cholecystitis between two periods (March and April 2019 and March and April 2020) at Emergency Surgery Department of Parma University Hospital, a tertiary COVID-Hospital. Results: A total of 72 patients underwent surgery between March and April 2019 and 36 between March and April 2020 for acute appendicitis and cholecystitis. The average length of stay was comparable in the two considered years for LA (4.23±1.69 days in 2019 versus 4.5±2.33 days in 2020). The average length of stay in patients with acute cholecystitis was 5.9±3.8 days in 2019 and 8.23±5.5 days in 2020(P=0.038). The average hospitalization was comparable with 2019 data (5.62±3.77 days)n March 2020;whereas, April 2020 was statistically significantly longer 10.5±6 days (P= 0.023). Conclusions: Half of the emergency centers reported a drop in the overall number of urgent cases as confirmed in our department, where the number of total appendicectomy and cholecystectomy was halved comparing the two months in 2019 and 2020, 72 operations in 2019 versus 36 operations in 2020.During the pandemic, the confidence of the population to the healthcare systems was poor, and this can explain the delayed access to the emergency department of patients who suffered from an acute illness. Bangladesh Journal of Medical Science Vol.19(0) 2020 p. S 66-S 68

scholarly journals Measuring Quality of Service in a Robotized Comprehensive Geriatric Assessment Scenario

2020 ◽  
Vol 10 (18) ◽  
pp. 6618
Author(s):  
Adrián Romero-Garcés ◽  
Jesús Martínez-Cruz ◽  
Juan F. Inglés-Romero ◽  
Cristina Vicente-Chicote ◽  
Rebeca Marfil ◽  
...  
Keyword(s):  
Quality Of Service ◽  
Functional Properties ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
User Preferences ◽  
Care Plans ◽  
Whole Process ◽  
Frail Elderly People ◽  
Individualised Care

Comprehensive Geriatric Assessment (CGA) is an integrated clinical process to evaluate frail elderly people in order to create therapy plans that improve their quality and quantity of life. The whole process includes the completion of standardized questionnaires or specific movements, which are performed by the patient and do not necessarily require the presence of a medical expert. With the aim of automatizing these parts of the CGA, we have designed and developed CLARC (smart CLinic Assistant Robot for CGA), a mobile robot able to help the physician to capture and manage data during the CGA procedures, mainly by autonomously conducting a set of predefined evaluation tests. Using CLARC to conduct geriatric tests will reduce the time medical professionals have to spend on purely mechanical tasks, giving them more time to develop individualised care plans for their patients. In fact, ideally, CLARC will perform these tests on its own. In parallel with the effort to correctly address the functional aspects, i.e., the development of the robot tasks, the design of CLARC must also deal with non-functional properties such as the degree of interaction or the performance. We argue that satisfying user preferences can be a good way to improve the acceptance of the robot by the patients. This paper describes the integration into the software architecture of the CLARC robot of the modules that allow these properties to be monitored at run-time, providing information on the quality of its service. Experimental evaluation illustrates that the defined quality of service metrics correctly capture the evolution of the aspects of the robot’s activity and its interaction with the patient covered by the non-functional properties that have been considered.

Improving service in an emergency department by designing the health production flow

2019 ◽  
Vol 33 (2) ◽  
pp. 76-85
Author(s):  
Oscar Barros ◽  
Rodrigo Riffo ◽  
Inti Paredes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Conservative Estimate ◽  
Health Production ◽  
Production Flow ◽  
Large Hospital ◽  
Direct Evaluation ◽  
Average Length Of Stay ◽  
Formal Design

Background Most emergency departments have overcapacity with poor service measured by length of stay. We hypothesized that a formal design of the emergency department production flows will improve service. Thus, we propose a methodology that was tested in a large hospital, including new flow implementation. Results We implemented new workflows during June to July 2017. A comparison of the patients’ average length of stay from June to September shows a decrease of 26%. Additionally, a comparison with 2016 shows a decrease of 50%. Direct evaluation of the value generated reveals an emergency department admissions increase of 540 monthly, equivalent of a savings of approximately US$250.000 annually. This savings is a very conservative estimate because the most significant value of this work is fast service that diminishes the patients’ risks. Conclusions Production design is an important problem in health services in terms of potential service improvements, executable with a formal, systemic, replicable method founded on several disciplines. Thus, we are replicating the approach at other hospitals with extensions to other services.

scholarly journals Comprehensive Geriatric Assessment in the perioperative setting; where next?

2019 ◽  
Vol 48 (5) ◽  
pp. 624-627 ◽  
Author(s):  
Jugdeep Dhesi ◽  
S Ramani Moonesinghe ◽  
Judith Partridge
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Geriatric Medicine ◽  
Cultural Barriers ◽  
Face Validity ◽  
Surgical Patients ◽  
National Audit ◽  
Services Research ◽  
Services Implementation ◽  
The Uk

Abstract Comprehensive Geriatric Assessment (CGA) is being employed in the perioperative setting to improve outcomes for older surgical patients. Traditionally CGA is delivered by a geriatrician led multidisciplinary team but with the acknowledged workforce challenges in geriatric medicine, it has been suggested that non-geriatricians may be able to deliver CGA. HOW-CGA developed a toolkit to facilitate the delivery of CGA by non-geriatricians in the perioperative setting. Across two hospital sites uptake and implementation of this toolkit was limited by a potential lack of face validity, behavioural and cultural barriers and an acknowledgement that geriatric medicine expertise is key to CGA and optimisation. In-keeping with this finding there has been an observed expansion in geriatrician led CGA services for older surgical patients in the UK. In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.

Patients in need of comprehensive geriatric assessment: The utility of the InterRAI emergency department screener

2021 ◽  
Vol 54 ◽  
pp. 100943
Author(s):  
Elfa Gretarsdottir ◽  
Anna Björg Jonsdottir ◽  
Ingibjörg Sigurthorsdottir ◽  
Ester Eir Gudmundsdottir ◽  
Ingibjörg Hjaltadottir ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment
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