Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

Zeitschrift für Gerontologie und Geriatrie, vol. 54, pp. 113–121

Abstract

OBJECTIVE: The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. METHODS: We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. RESULTS: Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). CONCLUSION: Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Authors 7

1. Laura C. Blomaard corresponding Aachen Department of Internal Medicine section Geriatrics

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands. l.c.blomaard@lumc.nl

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands

2. Bas de Groot Aachen Department of Emergency Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands

3. Jacinta Anna Lucke Aachen Department of Emergency Medicine

   Leiden University Medical Center · Spaarne Gasthuis

   Affiliation as printed

   Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands

   Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands

4. Jelle de Gelder Aachen Department of Internal Medicine section Geriatrics Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

5. Anja Martine Booijen Aachen Department of Emergency Medicine Department of Internal Medicine section Geriatrics

   Leiden University Medical Center

   Affiliation as printed

   Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands

6. Jacobijn Gussekloo Aachen Department of Internal Medicine section Geriatrics Department of Public Health and Primary Care

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands

   Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands

7. Simon P. Mooijaart Aachen Department of Internal Medicine section Geriatrics

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, 9600, 2300 RC, Leiden, The Netherlands

   Institute of Evidence-Based Medicine in Old Age | IEMO, Leiden, The Netherlands