Academic Emergency Medicine,
Journal Year:
2025,
Volume and Issue:
unknown
Published: March 28, 2025
Care
transitions
from
the
emergency
department
(ED)
to
community
represent
a
critical
period
that
can
significantly
impact
clinical
outcomes
of
older
adults,
yet
there
is
lack
standardized
tools
measure
patient-reported
experiences
and
during
this
transition.
Our
objective
was
develop
validate
Patient-Reported
Outcome
Measure-Older
adult
care
Transitions
in
ED
(PROM-OTED)
tool
transition
within
4-10
days
after
discharge.
Older
adults
(65+
years)
discharged
four
EDs
were
enrolled
between
November
2021
April
2024
multiphase
process:
qualitative
interviews,
item
generation,
member
checking,
cognitive
debriefing,
technical
expert
panel
review,
psychometric
evaluation
validation.
We
employed
descriptive
statistics,
analysis,
interitem
correlation,
factor
analyses
assess
tool's
validity
reliability.
Across
all
phases,
we
290
adults.
The
final
18-item
PROM-OTED
included
items
addressed
understanding
discharge
instructions,
medication
management,
follow-up
care,
quality
life.
demonstrated
feasibility
with
mean
(±SD)
completion
time
4.97
(±3.04)
min
able
be
administered
electronically
or
via
telephone.
additionally
excellent
internal
consistency
(Cronbach's
alpha
0.9376,
McDonald's
omega
0.9988)
good
test-retest
reliability
(r
=
0.8437).
Exploratory
analysis
supported
robust
structure
significant
correlations
Measure-3,
general
hospital
support
its
concurrent
validity.
reliable
preliminarily
valid
instrument
for
use
immediate
post-ED
period,
potential
applications
enhancing
practices
assessing
observational
interventional
studies.
BMC Health Services Research,
Journal Year:
2024,
Volume and Issue:
24(1)
Published: March 5, 2024
Abstract
Background
Globally,
emergency
departments
(EDs)
are
overcrowded
and
unable
to
meet
an
ever-increasing
demand
for
care.
The
aim
of
this
study
is
comprehensively
review
synthesise
literature
on
potential
solutions
challenges
throughout
the
entire
health
system,
focusing
ED
patient
flow.
Methods
An
umbrella
was
conducted
summarise
available
evidence
from
multiple
research
syntheses.
A
comprehensive
search
strategy
employed
in
four
databases
alongside
government
or
organisational
websites
March
2023.
Gray
reports
were
also
searched.
Quality
assessed
using
JBI
critical
appraisal
checklist
systematic
reviews
We
summarised
classified
findings
qualitative
synthesis,
Population-Capacity-Process
(PCP)
model,
input/throughput/output
(I/T/O)
model
flow
synthesised
intervention
outcomes
based
Quadruple
Aim
framework.
Results
yielded
1263
articles,
which
39
included
review.
Patient
interventions
categorised
into
human
factors,
management-organisation
interventions,
infrastructure
mapped
relevant
component
journey
pre-ED
post-ED
interventions.
Most
had
mixed
quadruple
nonsignificant
outcomes.
majority
enhancing
primarily
related
'within-ED'
phase
journey.
Fewer
identified
'post-ED'
(acute
inpatient
transfer,
subacute
hospital
at
home,
discharge
residential
care)
'pre-ED'
phase.
aligned
with
(QAIM),
aims
improve
care
experience,
enhance
population
health,
optimise
efficiency,
staff
satisfaction.
Conclusions
This
found
that
there
a
wide
range
used
address
flow,
but
effectiveness
these
varied,
most
focused
ED.
Interventions
remainder
largely
neglected.
metrics
reported
mainly
efficiency
measures
rather
than
addressing
all
quadrants
aim.
Further
needed
investigate
outside
improving
It
essential
develop
relate
three
phases
flow:
pre-ED,
within-ED,
post-ED.
Journal of the American Geriatrics Society,
Journal Year:
2022,
Volume and Issue:
70(11), P. 3152 - 3162
Published: July 2, 2022
Abstract
Background
Over
one‐half
of
older
adults
are
discharged
to
the
community
after
emergency
department
(ED)
visits,
and
studies
have
shown
there
is
increased
risk
adverse
health
outcomes
in
immediate
post‐discharge
period.
Understanding
experiences
during
ED‐to‐community
care
transitions
has
potential
improve
geriatric
clinical
inform
intervention
development.
We
therefore
sought
assess
barriers
experienced
by
transitions.
Methods
conducted
a
qualitative
analysis
community‐dwelling
cognitively
intact
patients
aged
65
years
receiving
four
diverse
EDs
from
single
U.S.
healthcare
system.
constructed
conceptual
framework
priori
guide
development
iterative
revision
codebook,
used
purposive
sampling,
recorded,
semi‐structured
interviews
using
standardized
guide.
Two
researchers
coded
professionally
transcribed
data
combined
deductive
inductive
approach
analyzed
transcripts
identify
dominant
themes
representative
quotations.
Results
Among
25
participants,
20
(80%)
were
women
17
(68%)
white.
identified
transition:
(1)
ED
discharge
process
was
abrupt
with
missing
information
regarding
symptom
explanation
performed
testing,
(2)
navigating
follow‐up
outpatient
challenging,
(3)
new
physical
limitations
fears
hinder
performance
baseline
activities,
(4)
major
minor
ramifications
for
caregivers
impact
an
adult's
willingness
request
or
accept
assistance.
Conclusions
Older
successful
that
can
novel
effective
interventions.
BMC Geriatrics,
Journal Year:
2024,
Volume and Issue:
24(1)
Published: Jan. 3, 2024
Abstract
Objective
Improving
care
transitions
for
older
adults
can
reduce
emergency
department
(ED)
visits,
adverse
events,
and
empower
community
autonomy.
We
conducted
an
inductive
qualitative
content
analysis
to
identify
themes
emerging
from
comments
better
understand
ED
transitions.
Methods
The
LEARNING
WISDOM
prospective
longitudinal
observational
cohort
includes
(≥
65
years)
who
experienced
a
transition
after
visit
both
before
during
COVID-19.
Their
on
this
were
collected
via
phone
interview
transcribed.
with
randomly
selected
until
saturation.
Themes
that
arose
coded
organized
into
frequencies
proportions.
followed
the
Standards
Reporting
Qualitative
Research
(SRQR).
Results
Comments
690
patients
(339
pre-COVID,
351
COVID)
composed
of
women
(50.9%)
339
men
(49.1%)
analyzed.
Patients
satisfied
acute
care,
proportion
positive
experiences
increased
COVID-19
pandemic.
Negative
patient
most
often
related
communication
between
health
providers
across
continuum
professionalism
personnel
in
ED.
concerning
home
became
more
neutral
Conclusion
overall
but
reported
gaps
follow-up
providers.
may
have
changed
tone
regarding
over
pandemic
due
service
slowdowns.
Addressing
these
concerns
improve
quality
provide
future
mitigation
strategies.
Journal of Alzheimer s Disease Reports,
Journal Year:
2025,
Volume and Issue:
9
Published: Jan. 1, 2025
The
emergency
department
evaluates
many
patients
with
undiagnosed
cognitive
impairment
and
presents
an
opportune
setting
to
facilitate
early
detection
referral
memory
care
specialists.
We
evaluated
a
novel
navigation
pathway
that
facilitated
referrals
of
ethnoculturally
diverse
individuals
suspected
from
geriatric
professionals
embedded
in
the
dementia
specialist
care.
compared
rates
successful
appointment
attendance
for
this
traditional
primary
provider
pathway.
team
successfully
identified
mitigated
multiple
barriers
accessing
care,
thereby
increasing
access.
Alzheimer s & Dementia,
Journal Year:
2025,
Volume and Issue:
21(4)
Published: April 1, 2025
Abstract
INTRODUCTION
Cognitive
impairment
(CI)
is
under‐recognized
by
emergency
department
(ED)
clinicians,
and
processes
for
cognitive
screening
outpatient
referrals
are
limited.
METHODS
This
pilot
study
tested
the
feasibility
of
ED
clinicians
referring
older
adult
patients
identified
through
CI
direct
clinician
referral
evaluation.
Telephone
interviews
chart
reviews
were
conducted
on
100
about
their
care,
function,
status.
RESULTS
A
total
9359
screened
memory
thinking
problems,
with
650
(6.9%)
reporting
such
issues.
discharged
referred
evaluation,
consisting
37
from
67
referral.
Of
these,
26
(26.0%)
scheduled
19
(19.0%)
completed
evaluations
within
days.
Fifteen
(78.9%)
formally
diagnosed
dementia,
CI,
or
loss.
DISCUSSION
able
to
identify
appropriately
refer
Future
studies
can
improve
rates
solutions
addressing
detection
follow‐up
challenges.
Highlights
Screening
evaluation
feasible
in
department.
Nearly
80%
who
impairment,
including
probable
dementia
Alzheimer's
disease.
Significant
gaps
barriers
remain
maintaining
initial
department,
less
than
one
five
completing
evaluations.
