• Acad Emerg Med · Mar 2015

    Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.

    • Linda M Schnitker, Melinda Martin-Khan, Ellen Burkett, Caroline A Brand, Elizabeth R A Beattie, Richard N Jones, Len C Gray, and Research Collaboration for Quality Care of Older Persons: Emergency Care Panel.
    • The Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia.
    • Acad Emerg Med. 2015 Mar 1;22(3):273-84.

    ObjectivesThe purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).MethodsA structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.ResultsAt the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.ConclusionsThis article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.© 2015 by the Society for Academic Emergency Medicine.

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