Synthesised Geriatric Assessment in the Emergency Department setting: is it NEAT?
Alan Nguyen A , Lahn Straney A , Peter Cameron A and Judy Lowthian A BA Monash University, School of Public Health and Preventive Medicine, Level 6 Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia.
B Corresponding author. Email: Judy.Lowthian@monash.edu
Australian Health Review 38(4) 370-376 https://doi.org/10.1071/AH13217
Submitted: 10 November 2013 Accepted: 6 May 2014 Published: 24 July 2014
Abstract
Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results.
Methods A convenience sample of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for individual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values < 0.05 were considered as statistically significant.
Results Time required for completion of the SGA by 90% of the study population was 20 min and 40 s. This represents approximately 8.6% of new 4-h ED targets. Secondary characteristics that affected the time taken for screening included patients from non-English-speaking backgrounds (P < 0.05).
Conclusions Use of the SGA for intra-ED geriatric risk stratification is feasible and practical in the time-critical National Emergency Access Target (NEAT) environment. The relatively short amount of time used for screening this vulnerable demographic has implications for interdisciplinary management and potentially represents an efficient intervention to reduce future re-presentations and overcrowding in Australian EDs. Future high-quality trials are required to assess the clinical benefit of the SGA.
What is known about the topic? The newly introduced ED NEAT encourages patient discharge from ED within 4 h of arrival, placing increased pressure on ED protocols to be time efficient, while still maintaining safe quality care. The Comprehensive Geriatric Assessment in inpatient and ED settings has demonstrated improved outcomes in populations aged > 65, including parameters of ED re-presentations, functional independence and short-term mortality. Geriatric emergency patient guidelines have been recently adopted in the US and UK which incorporate intra-ED geriatric screening processes. Studies focusing on the feasibility of geriatric screening in Australian EDs are scarce.
What does this paper add? Our pilot study focuses on the timing requirements of geriatric screening in time-critical ED environments. We analysed the time taken to conduct a SGA that was developed for a large research project, and the secondary patient characteristics that affected these times. Our paper provides valuable information for Australian EDs when considering the introduction of geriatric screening into EDs to optimise the care and outcomes of this patient group. Analysis of secondary patient characteristics and data patterns will further help EDs and future research into design of new protocols.
What are the implications for practitioners? The results of our pilot study suggest that use of the SGA in Australian ED settings is feasible and practical. By using the results of our pilot study, EDs and clinician researchers can make informed decisions about implementation of new protocol to manage older patients. We suggest that implementation of intra-ED geriatric screening assessments will result in improved patient outcomes, including long-term functional independence and decreased rates of ED re-presentation. This in turn would help to unclog our currently overloaded EDs.
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