Care of Older Adults in the Emergency Department

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Care of Older Adults in the Emergency Department

• A Community Development Approach to Influencing
  Attitudes, Knowledge and Practice
• Southeastern Regional Geriatric Program
• Brian Hart, Clinical Nurse Specialist
• Christine Knott, Program Evaluator
• Dr. John Puxty, Program Director

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Presentation Outline

• Principles of the CD approach
• Strategies utilized with the ED
• Successes and challenges
• Lessons learned
• Next Steps

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Community Development

• The process of organizing or supporting groups
  in identifying health issues, planning and acting
  upon strategies, and gaining increased
  self-reliance.
• Corber, 1993
• Canadian Journal of Public Health

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Community Development

• Community development is dental floss, because
  you need to apply it regularly for it to be
  effective, it often takes a long time to show
  healthy results, and it can sometimes be
  painful...

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Principles of Community Development

• Shared vision and accountability
• Key stakeholder participation
• Evaluation
• Sustainability and Portability

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Shared Vision and Accountability

• Development of project proposal
• Roles and responsibility document
• Commitment of resources
• Reporting

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Key Stakeholder Participation

• Regional Geriatric Program
• Emergency Department staff
• Hospital administration
• External Stakeholders
• CCAC, Psychogeriatrics

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Key Stakeholder Participation

• Communication Structures
• Steering committee
• Project development working group
• Ad hoc small group meetings

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Evaluation

• Retrospective ED data base analysis
• Site needs assessment
• Attitudes and practice assessment
• Review of literature and other initiatives
• Planning-oriented evaluation

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Sustainability and Portability

• Building relationships
• Enhancing capacity of ED staff
• Uniqueness of ED
• Ongoing evaluation
• Dissemination of model

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Successes

• Profile of the elderly in the ED
• Understanding of ED environment
• ED staff interest in the elderly
• ED referrals to the RGP
• Education sessions to staff
• Informed RGP planning

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Challenges

• Divergent principles of care expectations
• Physician participation and buy-in
• Planning with front-line staff
• Role clarification
• ED climate/readiness

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Lessons Learned

• Need to respond to ED expectations
• High level planning
• Increased attention to shared vision
• Consider ED readiness

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Next Steps

• Continue to evaluate
• Re-conceptualize approach
• Respond to ED requests
• Work with Hospital Administration and leadership
  re Elder Friendly Hospital Strategy