Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments. (March 2015)

• Record Type: Journal Article
• Authors: Schnitker, Linda M.; Martin‐Khan, Melinda; Burkett, Ellen; Brand, Caroline A.; Beattie, Elizabeth R. A.; Jones, Richard N.; Gray, Len C.; The Research Collaboration for Quality Care of Older Persons: Emergency Care Panel; Carpenter, Christopher R.
• Is Part Of: Academic emergency medicine. Volume 22:Number 3(2015:Mar.)
• Page Start: 273
• Page End: 284
• Publication Date: 2015-03
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.12617
• Languages: English
• ISSNs: 1069-6563

Abstract

<abstract abstract-type="main" id="acem12617-abs-0001"> <title>Abstract</title> <sec id="acem12617-sec-0001" sec-type="section"> <title>Objectives</title> <p>The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).</p> </sec> <sec id="acem12617-sec-0002" sec-type="section"> <title>Methods</title> <p>A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer‐reviewed and gray literature focusing on identification of evidence‐based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.</p> </sec> <sec id="acem12617-sec-0003" sec-type="section"> <title>Results</title> <p>At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.</p> </sec> <sec id="acem12617-sec-0004" sec-type="section"> <title>Conclusions</title> <p>This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.</p> </sec> </abstract>