A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review DOI Creative Commons
Sarah Filiatreault, Jeremy Grimshaw, Sara A. Kreindler

et al.

Journal of Evaluation in Clinical Practice, Journal Year: 2023, Volume and Issue: 29(6), P. 1039 - 1053

Published: June 14, 2023

Abstract Rationale Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED care challenging part due to a lack standards guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations improve Aim To critically appraise and synthesize CPG for relevant older patients. Methods We conducted an umbrella review retrieve CPGs. Quality CPGs their were appraised using Appraisal Guidelines, Research, Evaluation (AGREE)‐II; Guidelines Research Evaluation—Recommendations Excellence (AGREE‐REX) instruments. A threshold 70% greater AGREE‐II Rigour Development domain was used define high‐quality Delirium from meeting this included synthesis narrative analysis. Results scores ranged 37% 83%, with 5 10 predefined threshold. AGREE‐REX overall calculated 44% 80%. Recommendations grouped screening, diagnosis, reduction, management. Although none ED‐specific, many incorporated setting. There agreement that screening nonmodifiable factors important high‐risk populations, those should be screened delirium. The ‘4A's Test’ recommended tool use specifically. Multicomponent strategies its management if occurs. only area disagreement short‐term antipsychotic medication urgent situations. Conclusion This first known including critical appraisal recommendations. Researchers policymakers can inform future improvement efforts research ED. Registration study has been registered Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6 .

Language: Английский

Towards Optimizing Hospitalized Older adults' MEdications (TO HOME): Multi‐centre study of medication use and outcomes in routine care DOI Creative Commons
Sarah N. Hilmer, Sarita Lo, Patrick J. Kelly

et al.

British Journal of Clinical Pharmacology, Journal Year: 2023, Volume and Issue: 89(8), P. 2508 - 2518

Published: March 29, 2023

Comprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according Beers criteria; and cumulative anticholinergic sedative medication exposure calculated Drug Burden Index (DBI). Specifically, quantify these measures on admission, changes between admission discharge, associations adverse outcomes costs.Established new retrospective inpatient cohort 2000 adults aged ≥75 years, consecutively admitted 6 hospitals Sydney, Australia, detailed information medications, clinical characteristics outcomes. Conducted cross-sectional analyses index data from cohort.Cohort had mean (standard deviation) age 86.0 (5.8) 59% female, 21% residential care. On prevalence polypharmacy was 77%, PIMs 34% DBI > 0 53%. From difference (95% confidence interval) total number increased 1.05 (0.92, 1.18); while (-3.8% [-5.4, -2.1]) score (-0.02 [-0.04, -0.01]) decreased. were associated risks (adjusted odds ratio [95% interval]) falls (PIMs 1.63 [1.28, 2.08]; 1.21[1.00, 1.46]) delirium 1.76 [1.38, 1.46]; 1.42 [1.19, 1.71]). Each measure risk drug reactions (polypharmacy 1.71]; 1.87 [1.40, 2.49]; 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) contributing low ($0.29 $0.88).In this large inpatients, hospital results an increase small reductions DBI, variable

Language: Английский

Citations

9
Hospital Proximity and Emergency Department Use among Assisted Living Residents DOI
Brian E. McGarry, Yunjiao Mao,

Dallas Nelson

et al.

Journal of the American Medical Directors Association, Journal Year: 2023, Volume and Issue: 24(9), P. 1349 - 1355.e5

Published: June 7, 2023

Language: Английский

Citations

8
Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1–1.3 DOI Creative Commons
Colleen Cheek, Nematullah Hayba, Lieke Richardson

et al.

BMJ Open, Journal Year: 2023, Volume and Issue: 13(7), P. e072908 - e072908

Published: July 1, 2023

Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those present mental health condition, Indigenous Australians, culturally linguistically diverse (CALD) background. Strengthened performance relies on understanding the social systemic barriers preferences these different cohorts, identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims codesign, users providers, new adapted models improve performance, outcomes experience five cohorts. Experience-based codesign using mixed methods, set three hospitals one district Australia. This protocol introduces staged incremental approach whole project, details first research elements: ethnographic observations at interface, interviews providers two cohorts-older CALD We aim sample range participants, carefully tailoring recruitment support. Ethics approval has been obtained from Western Sydney Local Health District Human Research Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be all participants. Findings each stage submitted peer-reviewed publication. Project outputs disseminated implementation more widely across New South Wales,

Language: Английский

Citations

7
Impact of Geriatric Admissions on Workload in the Emergency Department DOI Open Access
Tomasz Kłosiewicz, Monika Rozmarynowska, Patryk Konieczka

et al.

Healthcare, Journal Year: 2023, Volume and Issue: 11(4), P. 593 - 593

Published: Feb. 16, 2023

Background: Due to the increase in life expectancy, both general population and of patients emergency departments (ED) are getting older. An understanding differences, workload resource requirements may be helpful improving patient care. The main goal this study was evaluate reasons for geriatric admissions ED, identify typical medical problems assess number resources order provide more effective management. Methods: We examined 35,720 elderly patients' ED visits over course 3 years. data collected included age, sex, timing length stay (LOS), use various resources, endpoint (admission, discharge or death) ICD-10 diagnoses. Results: median age 73 years [66-81], with females (54.86%). There were 57.66% (G1), 36.44% senile (G2) 5.89% long-liver (G3) patients. older groups. total admission rate 37.89% (34.19% G1, 42.21% G2 47.33% G3). average patient's 150 min [81-245] (G3 180 [108-277], (162 [92-261]) G1 139 [71-230]). Heart failure, atrial fibrillation hip fracture most common Nonspecific diagnoses all Conclusion: vast majority required considerable resources. With increasing ages, women, LOS increased.

Language: Английский

Citations

6
A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review DOI Creative Commons
Sarah Filiatreault, Jeremy Grimshaw, Sara A. Kreindler

et al.

Journal of Evaluation in Clinical Practice, Journal Year: 2023, Volume and Issue: 29(6), P. 1039 - 1053

Published: June 14, 2023

Abstract Rationale Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED care challenging part due to a lack standards guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations improve Aim To critically appraise and synthesize CPG for relevant older patients. Methods We conducted an umbrella review retrieve CPGs. Quality CPGs their were appraised using Appraisal Guidelines, Research, Evaluation (AGREE)‐II; Guidelines Research Evaluation—Recommendations Excellence (AGREE‐REX) instruments. A threshold 70% greater AGREE‐II Rigour Development domain was used define high‐quality Delirium from meeting this included synthesis narrative analysis. Results scores ranged 37% 83%, with 5 10 predefined threshold. AGREE‐REX overall calculated 44% 80%. Recommendations grouped screening, diagnosis, reduction, management. Although none ED‐specific, many incorporated setting. There agreement that screening nonmodifiable factors important high‐risk populations, those should be screened delirium. The ‘4A's Test’ recommended tool use specifically. Multicomponent strategies its management if occurs. only area disagreement short‐term antipsychotic medication urgent situations. Conclusion This first known including critical appraisal recommendations. Researchers policymakers can inform future improvement efforts research ED. Registration study has been registered Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6 .

Language: Английский

Citations

6