Patient Experience After Geriatric Emergency Medicine Assessment

Abstract

Introduction: The geriatric population is increasing in size and is expected to represent 20% of the United States population by 2030 per US census data estimates, with an expectant increase in geriatric emergency department (ED) visits. 1 Prior research has demonstrated older adults evaluated in the ED are more likely to have an increased length of stay, more diagnostic tests, and higher overall costs than their younger counterparts, but despite consuming greater resources and staff time, older adults are still more likely to be dissatisfied with their treatment outcomes and less likely to feel that their presenting complaint has been resolved. 2, 4 In 2013 the American Academy of Emergency Physicians began a formal accrediting process for Geriatric Emergency Departments, 3 and the Beaumont Royal Oak ED implemented a Geriatric Assessment Team (GAT) while in the process of obtaining this accreditation. The primary objective of this qualitative study was to assess the older patient’s experience and perception of the care they received in the emergency department after evaluation by the Geriatric Assessment Team and determine if patients would recommend the continuation of this program. Methods: Patients aged 65 and older that do not live in a nursing home and presented to the ED from the community Monday through Friday between 9 AM to 5 PM were screened using the Identifying Seniors at Risk Questionnaire. Those who scored 2 or higher underwent additional testing to further assess cognition, fall risk, risk of polypharmacy. Patients who screened positive on any of these tests received additional care coordination including physical and occupational therapy evaluations, home care, and medical equipment. When workup was completed, a 6-question survey was administered to assess satisfaction with the program elements on a scale from 1 (very dissatisfied) to 5 (very satisfied), with opportunity to provide additional comments. Results: From November 2020 through May 2021, 258 surveys were collected. The average age of responders was 79 and 40% of responders identified as male. 46.1% of surveyed patients were discharged, 34% admitted, 18% placed in the observation unit, 1.6% were discharged directly to a subacute rehab facility, and 1 left AMA. Respondents on average rated the program overall 4.59, between satisfied (4) and very satisfied (5). The average rating of satisfaction with the information provided about the program was 4.6, the average satisfaction with the explanation of the patient’s evaluation results was 4.5, and the average rating of follow up instructions was 4.5. 87% of patients responded when asked if the program should be continued, with 99.5% of those indicating that they recommend the program be continued. Conclusion: In this study, patients who underwent assessment by the Geriatric Assessment Team reported appreciation of the care they received with a majority recommending the program be continued. Developing an understanding of the experience of this growing and unique patient population is essential to improve satisfaction and quality of care provided in the ED as older adults become an increasing proportion of the patient population.