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

项目总结/摘要 该项目将实施一个两步协议，在紧急情况下进行多学科老年评估。 部门（艾德）和发展有前途的研究人员成为专家实施科学和质量 改进.候选人：Lauren Southerland博士是一名接受过老年和急诊医学培训的医生， 俄亥俄州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1级 在中西部的老年艾德，并有在艾德和在艾德观察老年人的护理事先研究 单位培训：职业发展计划将建立在Southerland博士独特的奖学金培训基础上， 老年急诊医学与课程的实施和传播科学，黑带 精益六西格玛，并通过公共卫生硕士课程进行研究设计，研究伦理和统计培训 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 将老年护理的有效要素转化为急诊医学的日常实践。 导师/环境：Southerland博士拥有经验丰富的导师团队，他们将在以下方面提供指导： 紧急情况研究的复杂性（博士杰弗里Caterino，医学博士，公共卫生硕士主要导师），实施战略 医院工作人员和护士的研究（Lorraine Mion博士），实施框架和报告 (Dr.位于圣路易斯的华盛顿大学的EM医生克里斯托弗·卡彭特）， 高质量护理的环境和人为因素障碍（Susan Moffatt-Bruce博士，医学博士，公共卫生硕士，血管 外科医生、研究员和俄勒冈州立大学医院的执行主任）。项目：多学科评估， 老年病学家、物理治疗师、病例管理者和药剂师确定并解决潜在的 老年艾德患者的老年问题。然而，全国只有少数急诊室能够 由于人员成本、工作流程等障碍， 培养和24小时艾德护理模式。我们制定了一个两步方案来解决这些障碍： 第一步是艾德护士使用快速、敏感的屏幕来检查跌倒风险（4阶段平衡测试）、谵妄（短暂谵妄 分类筛选）和脆弱性（识别老年人风险评分）。有相关结果的患者将被安置在 一个艾德观察单位（步骤2）多学科老年评估。使用艾德观察装置 这些扩展的评估克服了许多以前确定的多学科老年医学的障碍， 考核在目标1中，我们将使用实施研究的综合框架和精益六 西格玛方法，以确定和解决全面实施的剩余障碍。目标2将评估 本方案在以患者为导向的结局（功能状态和健康相关 90天的生活质量）。通过使用实现框架和流程，我们将开发一个协议， 有效、可持续、适应艾德文化和工作流程，并随时准备向全世界的ED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.