Comparison between the Identification of Seniors at Risk and Triage Risk Screening Tool in predicting mortality of older adults visiting the emergency department: Results from Indonesia

Introduction: Patients from all population groups visit the emergency department (ED), with increasing visits by elderly patients. Patient falls in the ED are a significant safety concern, and they can lead to serious injuries and worse outcomes. Toronto Western Hospital’s ED Quality Improvement (QI) team identified as a problem our assessment and management of patients at risk for falls. The aim of this project was to develop a comprehensive and standardized approach to patients at risk of falls in the ED, including implementing timely interventions for fall prevention. Methods: A literature review of existing tools was completed to develop our own reliable and valid fall risk screening tool for ED patients. QI methods were used to devise a comprehensive strategy starting with detection at triage and implementation of action-driven steps at the bedside, through multiple PDSA cycles, randomized audits, surveys, and education. Repeated measurements were undergone throughout the project, as were staff satisfaction surveys. Results: The chart audits showed a five-fold increase in the completion rate of the fall risk screening tool in the ED by the end of the QI initiative (from 10% to 50%). Constructive feedback by an engaged team of nurses was used to iteratively improve the tool, and there was mostly positive feedback on it after various PDSA cycles were completed. The various component of this novel and useful ED-based falls screening tool and bundle will be presented in tables and figures for other leaders to replicate in their EDs. Conclusion: We developed a completely new ED-specific fall risk screening tool through literature review, front-line provider feedback, and iterative PDSA cycles. It was used for the identification, prevention, and management of ED patients with fall risk. We also contributed to a positive change in the culture of a busy ED environment towards the promotion of patient safety. Education and feedback continue to be provided to the ED nurses for reflective practice, and we hope to continue to improve our tool and to share it with other EDs.

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OP58 Adverse outcomes in older adults attending emergency department: a systematic review and meta-analysis of the identification of seniors at risk (ISAR) screening tool

Journal of Epidemiology & Community Health ◽

10.1136/jech-2015-206256.57 ◽

2015 ◽

Vol 69 (Suppl 1) ◽

pp. A34.2-A34

Author(s):

R Galvin ◽

Y Gilleit ◽

M Bolmer ◽

E Wallace ◽

S Smith ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

At Risk ◽

Emergency Department ◽

Screening Tool ◽

Meta Analysis ◽

Adverse Outcomes

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Hospital readmission among older adults with congestive heart failure

Australian Health Review ◽

10.1071/ah12042 ◽

2013 ◽

Vol 37 (3) ◽

pp. 362 ◽

Cited By ~ 14

Author(s):

Tasneem Islam ◽

Beverly O'Connell ◽

Prabha Lakhan

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Older Adults ◽

At Risk ◽

Congestive Heart Failure ◽

Screening Tool ◽

Aged Care ◽

Risk Screening ◽

Factors Associated ◽

Readmission Risk

Introduction. To examine the factors associated with unplanned readmission among older adults with congestive heart failure (CHF) within 28 days of discharge from an index admission, within a large Australian health service. Methods. Using a comparative cohort design, a multivariate logistic regression model was used to compare readmitted patients with non-readmitted patients and identify risk factors associated with readmission. Results. Significant risk factors identified were male gender, numerous diagnoses, length of stay 3 days or longer and patients being admitted from acute, subacute or aged-care facilities. Conclusions. The high risk of patients being readmitted from acute, subacute and aged-care services requires further review as these readmissions may be avoidable. It may also be useful to develop a readmission risk screening tool so that patients at risk of readmission can be identified. What is known about this topic? Older adults with CHF are likely to experience multiple readmissions to hospital. There have been several studies conducted on hospital readmissions; however, generalising the findings is problematic due to the use of variable definitions of what constitutes a readmission. What does this paper add? This paper addresses the absence of Australian research comparing groups of older patients with CHF who are readmitted to hospital with those who are not readmitted. It also adopts one of the more frequently used definitions of readmission to aid in future comparability of research. What are the implications for practice? Further work is necessary to improve discharge planning and effectively manage chronic illnesses such as CHF in patients’ homes. It may be useful to develop a readmission risk screening tool for staff of inpatient medical wards so that these at-risk patients can be identified before discharge.

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