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

在急诊室观察室 (IMAGE) 对老年患者实施多学科评估

• 批准号: 10589789
• 负责人: Lauren T. Southerland
• 金额: $ 15.91万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589789
• 关键词: Accident and Emergency department; Accreditation; Address; Adherence; Affect; Attention; Black race; Blood Vessels; Caring; Case Manager; Clinical Research; Conduct Clinical Trials; Consolidated Framework for Implementation Research; Consult; Counseling; Country; Data; Delirium; Development Plans; Dissemination and Implementation; Doctor of Philosophy; Effectiveness; Elderly; Elements; Emergency Care; Emergency Department Physician; Emergency Department patient; Emergency Medicine; Emergency Nursing; Emergency department visit; Emergency research; Environment; Fall prevention; Fellowship; Geriatric Assessment; Geriatrics; Goals; Guidelines; Health; Hospitalization; Hospitals; Hour; Human; Human Resources; Hybrids; Incentives; Injury; Institution; Institutionalization; Intervention; Interview; Lead; Length; Medical center; Mentors; Mentorship; Methodology; Methods; Midwestern United States; Minor; Modeling; Monitor; Nurses; Ohio; Outcome; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Physicians; Play; Polypharmacy; Positioning Attribute; Process; Protocols documentation; Public Health; Quality of Care; Reporting; Research; Research Design; Research Ethics; Research Personnel; Residual state; Resources; Risk; Role; Surgeon; Surveys; Syndrome; System; Testing; Thinness; Time; Training; Translating; Triage; United States; Universities; Visit; Washington; Withdrawal; Work; balance testing; career; career development; cohort; cost; design; dissemination science; effectiveness evaluation; effectiveness/implementation study; experience; fall risk; falls; frailty; functional decline; functional status; health care settings; health related quality of life; high risk; implementation barriers; implementation framework; implementation process; implementation research; implementation science; implementation strategy; implementation study; improved; medical specialties; mortality; multidisciplinary; novel strategies; older patient; physical therapist; post implementation; prevent; process improvement; recruit; risk stratification; screening; secondary outcome; social; standard of care; statistics; tool

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.

项目概要/摘要 该项目将实施紧急情况下多学科老年病评估的两步方案 部门（ED）并将一名有前途的研究员培养成实施科学和质量方面的专家 改进。候选人：Lauren Southerland 博士是一位接受过老年医学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经过认证的 Level 1 中西部的老年急诊科，并在急诊科和急诊科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 Southerland 博士在以下领域的独特奖学金培训的基础上： 老年急诊医学，包括实施和传播科学课程，黑带 精益六西格码，以及通过公共卫生硕士进行研究设计、研究伦理和统计学方面的培训 课程。这种结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：Southerland 博士拥有一支经验丰富的导师团队，他们将在以下方面提供指导： 应急研究的复杂性（Jeffrey Caterino 博士，医学博士，公共卫生硕士主要导师）、实施策略 医院工作人员和护士的研究（Lorraine Mion 博士）、实施框架和报告 （克里斯托弗·卡彭特 (Christopher Carpenter) 博士，圣路易斯华盛顿大学的一名 EM 医师），并确定 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、俄勒冈州立大学医院执行董事）。项目：多学科评估 老年病学家、物理治疗师、病例经理和药剂师识别并解决潜在的问题 老年 ED 患者的老年问题。然而，全国只有少数 ED 能够做到这一点。 由于人员成本、工作流程等障碍，对老年患者进行多学科护理 文化和 24 小时 ED 护理模式。我们制定了一个两步协议来解决这些障碍： 第 1 步是急诊室护士使用快速、灵敏的屏幕来检测跌倒风险（4 阶段平衡测试）、谵妄（短暂谵妄） 分类筛查）和虚弱（识别处于风险评分的老年人）。结果令人担忧的患者将被安置在 急诊室观察室，用于（第 2 步）多学科老年病评估。使用 ED 观察装置 这些扩展评估克服了先前发现的多学科老年医学障碍 评估。在目标 1 中，我们将使用实施研究综合框架和精益六项 西格玛方法用于识别和解决全面实施的剩余障碍。目标 2 将评估 该协议在以患者为导向的结果（功能状态和健康相关）方面的有效性 90 天的生活质量）。通过使用实施框架和流程，我们将开发一个协议 有效、可持续、适应 ED 文化和工作流程，并准备好向整个 ED 传播 我们。

项目成果

An implementation science approach to geriatric screening in an emergency department.

• DOI: 10.1111/jgs.17481
• 发表时间: 2022-01
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Southerland LT;Hunold KM;Van Fossen J;Caterino JM;Gulker P;Stephens JA;Bischof JJ;Farrell E;Carpenter CR;Mion LC
• 通讯作者: Mion LC

Physical therapy consultation in the emergency department for older adults with falls: A qualitative study.

• DOI: 10.1002/emp2.12941
• 发表时间: 2023-04
• 期刊: JOURNAL OF THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS OPEN
• 影响因子: 2.3
• 作者: Chary, Anita;Brickhouse, Elise;Torres, Beatrice;Cameron-Comasco, Lauren;Lee, Sangil;Punches, Brittany;Skains, Rachel M;Naik, Aanand D;Quatman-Yates, Catherine C;Kennedy, Maura;Southerland, Lauren T;Liu, Shan
• 通讯作者: Liu, Shan

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department.

• DOI: 10.1111/acem.13998
• 发表时间: 2020-10
• 期刊: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
• 作者: Southerland LT;Savage EL;Muska Duff K;Caterino JM;Bergados TR;Hunold KM;Finnegan GI;Archual G
• 通讯作者: Archual G

Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments.

检查 1 级和 2 级老年急诊科实施的老年护理流程。

• DOI: 10.17294/2694-4715.1041
• 发表时间: 2022
• 期刊: Journal of geriatric emergency medicine
• 作者: Santangelo,Ilianna;Ahmad,Surriya;Liu,Shan;Southerland,LaurenT;Carpenter,Christopher;Hwang,Ula;Lesser,Adriane;Tidwell,Nicole;Biese,Kevin;Kennedy,Maura
• 通讯作者: Kennedy,Maura

Applying Geriatric Principles to Transitions of Care in the Emergency Department.

将老年原则应用于急诊室的护理过渡。

• DOI: 10.1016/j.emc.2021.01.006
• 发表时间: 2021-05
• 期刊: Emergency medicine clinics of North America
• 影响因子: 1.2
• 作者: Bambach K;Southerland LT
• 通讯作者: Southerland LT