A Randomized Controlled Trial of Geriatric Emergency Department Innovations

项目摘要 老年患者使用急诊科（艾德）比任何其他年龄组。一旦进了艾德， 老年患者住院时间更长，接受更多的诊断测试， 比年轻人更容易住院。老年患者的艾德访视是哨点健康事件。如果老年患者 出院后，他们经常返回艾德或住院，并经历健康相关质量的下降 生命（HRQoL）和残疾。如果他们住院，他们的费用会增加，穷人的风险也会更大。 结果包括感染、谵妄和福尔斯。老年患者的次优急性护理是一个问题 在全国范围内，制定了国家老年急诊科指南，并得到了 突出的利益相关者群体。为了改善老年患者的急诊护理，西北纪念医院 实施老年急诊科创新（GEDI）计划。GEDI是一个综合的， 对老年患者进行艾德护理的跨学科方法;它应用循证方案来改善艾德 关心和改善从艾德到社区的过渡。该计划的中心是老年护理联络 （GNL）是艾德护士，受过老年病学方面的额外培训， 比传统的床边护理更好当艾德团队咨询时，GNL进行验证评估， 协调艾德、医院或门诊病人的护理。通过这种评估和协调 GEDI提供以病人为中心的护理，旨在防止不必要的住院。虽然GEDI 是建立在现有的最佳证据，并反映了老年急诊科的指导方针 在多个国家利益相关者团体的支持下，美国没有艾德的前瞻性疗效研究- 为像GEDI这样的老年患者提供的基于项目。因此，GEDI的功效尚未得到检验 前瞻性地。我们提出了一个随机对照试验（RCT），以确定GEDI的疗效在高- 城市医院的容量。此外，确定最有可能从GEDI中受益的患者是困难的。可用 工具对住院、返回艾德和功能衰退的预测有效性较差。然而，在这方面， 由AHRQ资助开发的“紧急老年病审查和评估工具”（EGRET）， 这是一个很有前途的筛选工具，可以识别出可能从GEDI中受益的老年人。将加强性别平等和发展倡议的一项随机对照试验 通过使用EGRET来筛选有不良结局风险的老年患者。本研究涉及若干AHRQ 优先人群：妇女、少数民族、市中心、寿命结束、低收入和老年人。

Project Summary Geriatric patients use the emergency department (ED) more than any other age group. Once in the ED, geriatric patients have longer stays, receive a greater number of diagnostic tests, and are more likely to be hospitalized than younger adults. ED visits for geriatric patients are sentinel health events. If geriatric patients are discharged, they often return to the ED or are hospitalized and experience declines in health-related quality of life (HRQoL) and disability. If they are hospitalized, they incur increased costs and greater risk for poor outcomes including infections, delirium, and falls. Suboptimal acute care for geriatric patients is a problem nationally, resulting in development of national geriatric emergency department guidelines and endorsement by prominent stakeholder groups. To improve acute care for geriatric patients, Northwestern Memorial Hospital implemented the Geriatric Emergency Department Innovations (GEDI) program. GEDI is an integrated, interdisciplinary approach to ED care for geriatric patients; it applies evidence-based protocols to improve ED care and improve transitions from the ED to the community. The program centers on geriatric nurse liaisons (GNLs) who are ED nurses with additional training in geriatrics and whose time is dedicated to GEDI rather than traditional bedside nursing. When consulted by the ED team, GNLs perform validated assessments and coordinate patient care in the ED, hospital, or outpatient setting. Through this assessment and coordination model, GEDI provides patient-centered care and aims to prevent unnecessary hospitalizations. Though GEDI was built on the best available evidence, and reflects the Geriatric Emergency Department guidelines supported by multiple national stakeholder groups, there are no prospective efficacy studies in the U.S. of ED- based programs for geriatric patients like GEDI. Therefore, GEDI's efficacy has not been tested prospectively. We propose a randomized controlled trial (RCT) to determine the efficacy of GEDI at a high- volume, urban hospital. Additionally, identifying patients most likely to benefit from GEDI is difficult. Available instruments have poor predictive validity for hospitalization, return to the ED, and functional decline. However, the “Emergency Geriatric Review and Evaluation Tool” (EGRET), which was developed with AHRQ funding, is a promising screener to identify older adults who may benefit from GEDI. A RCT of GEDI will be strengthened by using EGRET to screen geriatric patients at risk of poor outcomes. This study addresses several AHRQ priority populations: women, minorities, inner-city, End-of-Life, low income and the elderly.