Implementation of Multidisciplinary Assessments for Geriatric Patients in an ED Observation Unit (IMAGE)

项目摘要/摘要 该项目将执行紧急情况下多学科老年评估的两步方案 将一名有前途的研究人员培养成实施科学和质量方面的专家 进步了。候选人：劳伦·索瑟兰博士是一名接受过老年和急诊医学培训的医生， 俄亥俄州立大学韦克斯纳医学中心(OSU)。她设计并领导了第一个认证的一级 中西部老年性勃起功能障碍，并在勃起功能障碍和勃起功能障碍观察中对老年人的护理进行了先前的研究 单位。培训：职业发展计划将建立在索瑟兰博士在 老年急诊医学，实施和传播科学，黑带 精益六西格玛，并通过公共卫生硕士学位在研究设计、研究伦理和统计方面进行培训 课程。这一组合将使她成为实施研究方面的专家，其职业目标是 将经过验证的、有效的老年护理要素转化为急诊医学的日常实践。 导师/环境：索瑟兰博士有一个经验丰富的导师团队，他们将在 紧急研究的复杂性(杰弗里·卡特里诺博士，医学博士，公共卫生硕士主要导师)，实施战略 以及对医院工作人员和护士的研究(Lorraine Mion博士，博士)、执行框架和报告 (克里斯托弗·卡彭特博士，圣路易斯华盛顿大学的EM内科医生)，并确定 高质量护理的环境和人为因素障碍(苏珊·莫法特-布鲁斯博士，医学博士，公共卫生硕士，血管 外科医生、研究员和俄亥俄州立大学医院执行主任)。项目：多学科评估 老年科医生、物理治疗师、病例经理和药剂师确定并解决潜在的问题 老年ED患者的老年问题。然而，全国只有少数几个急救人员能够 由于人员成本、工作流程等障碍，整合对老年患者的多学科护理 文化，以及24小时急诊护理模式。我们已经制定了一个分两步走的协议来解决这些障碍： 第一步是急诊护士使用快速、灵敏的筛查，以防止跌倒风险(4级平衡测试)、妄想(短暂妄想) 分类筛选)和脆弱(识别处于风险中的老年人的分数)。结果令人担忧的患者将被安置在 一个ED观察组，用于(步骤2)多学科老年评估。使用ED观察单元进行 这些扩展的评估克服了许多以前确定的多学科老年病的障碍 评估。在目标1中，我们将使用实施研究综合框架和精益六 西格玛方法识别和解决全面实施的残余障碍。目标2将评估 该方案在以患者为导向的结果(功能状态和与健康有关)方面的有效性 90天的生活质量)。通过使用实现框架和流程，我们将开发一种协议， 有效、可持续、适应教育文化和工作流程，并准备好向整个教育部门传播 我们。

PROJECT SUMMARY/ABSTRACT This project will implement a two-step protocol for multidisciplinary geriatric assessment in the Emergency Department (ED) and develop a promising researcher into an expert in Implementation Science and Quality Improvement. Candidate: Dr. Lauren Southerland is a Geriatric- and Emergency Medicine-trained physician at The Ohio State University Wexner Medical Center (OSU). She designed and leads the first accredited Level 1 Geriatric ED in the Midwest and has prior research on the care of older adults in the ED and in ED Observation Units. Training: The career development plan will build upon Dr. Southerland's unique fellowship training in Geriatric Emergency Medicine with courses in Implementation and Dissemination Science, a Black Belt in Lean Six Sigma, and training in study design, research ethics, and statistics through Master's in Public Health courses. This combination will position her as an expert in Implementation research, with the career goal of translating validated, effective elements of geriatric care into the day to day practice of Emergency Medicine. Mentors/Environment: Dr. Southerland has an experienced mentorship team who will provide guidance in the intricacies of emergency research (Dr. Jeffrey Caterino, MD, MPH primary mentor), implementation strategies and studies of hospital staff and nurses (Dr. Lorraine Mion, PhD), implementation frameworks and reporting (Dr. Christopher Carpenter, an EM physician at Washington University at St. Louis), and identifying environmental and human factor barriers to high quality care (Dr. Susan Moffatt-Bruce, MD, MPH, a vascular surgeon, researcher, and Executive Director of OSU Hospital). Project: Multidisciplinary assessment by geriatricians, physical therapists, case managers, and pharmacists identifies and addresses underlying geriatric issues in older ED patients. However, only a few EDs across the country have been able to incorporate multidisciplinary care for their older patients, due to barriers such as personnel costs, work flow culture, and the 24 hour ED care model. We have developed a two-step protocol to address these barriers: Step 1 is ED nurses using quick, sensitive screens for fall risk (4 Stage Balance Test), delirium (Brief Delirium Triage Screen), and frailty (Identifying Seniors at Risk Score). Patients with concerning results will be placed in an ED Observation Unit for (step 2) multidisciplinary geriatric assessment. Using an ED Observation Unit for these extended assessments overcomes many of the previously identified barriers to multidisciplinary geriatric assessment. In Aim 1 we will use the Consolidated Framework for Implementation Research and Lean Six Sigma methods to identify and address residual barriers to full implementation. Aim 2 will evaluate the effectiveness of this protocol in regards to patient-oriented outcomes (functional status and health-related quality of life at 90 days). By using implementation frameworks and processes, we will develop a protocol that is effective, sustainable, adapted to ED culture and work flow, and ready for dissemination to EDs across the US.