Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool.
Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool.
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利用退伍军人管理局老年急诊科认证，使用标准化工具改善老年退伍军人的虐待行为检测。
DOI：
10.1111/acem.14646
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
McQuown,ColleenM
中科院分区：
文献类型：
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作者：
Makaroun,LenaK;Halaszynski,JaimeJ;Rosen,Tony;Haggerty,KristinLees;Blatnik,JenniferK;Froberg,Ruthann;Elman,Alyssa;Geary,ChristineA;Hagy,DyanM;Rodriguez,Crescencio;McQuown,ColleenM
虐待老年人(EA)很常见，对健康有毁灭性的影响，但大多数情况下都没有被发现，限制了干预的机会。在退伍军人健康管理局(VHA)接受护理的老年退伍军人是EA的高危人群。VHA急诊科(ED)就诊提供了识别EA的独特机会，因为对急性伤害或疾病的评估可能是孤立的老年退伍军人离开家的唯一时间，但大多数VHA急诊科没有标准化的EA评估方案。为了解决这个问题，我们组建了一个由VHA社会工作者、医生、护士、中级护理技术员(ICT；经常在VHA急诊室进行筛查的前军医和医护人员)以及VHA和非VHA EA主题专家组成的跨学科团队，以使老年人虐待筛查和反应工具(EM-SART)适用于路易斯托克斯克利夫兰退伍军人医学中心老年教育(GED)计划的试点。他们方法的基石是由ICT和护士领导的跨学科GED会诊，他们筛查高危老年退伍军人的老年综合征和未得到满足的需求。经调整的EM-SART于2020年12月被纳入电子健康记录和GED工作流程。截至2022年7月，共有251名退伍军人接受筛查，其中9名(3.6%)前筛阳性，5名(2%)全面筛查阳性。基于第一年的试点经验，跨学科团队被扩大并定期召开会议，以进一步调整EM-SART以在VHA中更广泛地使用，包括为有执照和无执照的临床医生提供完成筛查工具的灵活性，并针对VHA政策和资源定制响应选项。VHA急救员改善老年退伍军人护理和获得GED认证的全国性势头为将这种基于证据的EA评估方法嵌入美国最大的综合医疗系统提供了独特的机会。
Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high‐risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non‐VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM‐SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high‐risk older Veterans for geriatric syndromes and unmet needs. The adapted EM‐SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first‐year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM‐SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence‐based approach to EA assessment in the largest integrated health system in the United States.