POSTER ABSTRACTS

A Survey of ED Staff about Challenges and Recommendations forEmergency Department Care of Extended Care Facility Patients

Presenting Author: Myriam Edwards, MD, Hurley Medical Center

Author(s): Myriam Edwards, MD, Purushottam Naik, MD,

Ghassan Bachuwa, MD, MS, MSHA, Nicolas Lecea, BS;

and Julie Campe, BA, CCRC

Introduction/Objective: Extended care facility (ECF) patients who transfer

to emergency departments can pose problems when complicated health prob-

lems require extra resources, without easy resolution. Higher numbers of older

patients are projected to use emergency departments, so health researchers

recommend that health care professionals prepare for an increasing aging

population who may present with multiple special needs. Our aim was to so-

licit views and opinions of emergency department personnel about key issues

related to emergency care of ECF residents and to identify top problems to

explore possible solutions and plan for the future.

Design/Methodology: A confidential, anonymous survey of ED staff mea-

sured knowledge and attitudes related to care of older adults transferred to

the ED from ECFs. As an incentive, participants could enter a drawing for

two $25 gift cards. Based on published literature, the survey targeted commu-

nication problems, patient satisfaction concerns, difficult characteristics of

patient population, need for education, and need for research. Format was

Likert-scale and open-ended comments and included key demographics. Set-

ting: 443-bed, public, non-profit, safety net medical center in mid-size urban

area in Midwest, with .88,000 annual emergency cases. Population: 253

emergency department clinical staff, including: physicians, nurses, resident

physicians, fellows, and medical students. Results were analyzed using de-

scriptive and inferential statistics.

Results: Flawed communication: Most commonly cited cause of patient dis-

satisfaction with ED care. Split responses: Physicians and nurses split on role

of pharmacological challenges; resident physicians differed from others in

whether ED staff was ‘‘comfortable’’ in managing older patients. Improved

documentation: Top item identified to improve outcomes for ECF patients

seen in ED. Research focus: Patient improvement factors is top response.

Challenges & training: 3 domains were identified as treatment challenges.

Conclusion/Discussion: Increased communication between all levels of ge-

riatric care is recommended. Age alone puts this cohort of patients in a ‘‘spe-

cial needs’’ category. ED staff said communication is a top problem but not

a top training priority. They want nursing homes and EMS providers to doc-

ument and communicate; but for their own training needs, they specified:

Special needs of older adults, detecting abuse in older adults, specific medical

and psychosocial issues associated with older adults. Implications: Since pop-

ulation projections indicate an increasing trend of older adults, health care

providers must think ahead and prepare for future medical needs. While sur-

vey research is never robust, it is affordable and useful. We plan to use the

survey results to initiate collaboration with ED staff, EMS providers, and

ECF staff to identify specific improvements in order to improve acute care

for elderly patients – for the present and well into the future. We encourage

other institutions to do the same.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

After Hours Communications between Providers and Long Term CareStaff in a Community Based Setting

Presenting Author: Y. Ye, MD, University of Texas Health Science Center

Author(s): Y. P. Ye, MD, M. Rosina Finley, MD, CMD,

Robert C. Wood, PhD, Johanna Becho, S. Liliana Oakes, MD;

and David V. Espino, MD

Introduction/Objective: The purpose of this study was to characterize after

hours telephone communications with health care providers in community-

based nursing homes (NH’s), including skilled nursing facilities (SNF’s) as

well as assisted living facilities (AL’s) in metropolitan San Antonio.

Design/Methodology: We conducted a prospective observational study

evaluating the selected NH’s for all after hours telephone calls from

POSTER ABSTRACTS

approximately 353 long term care patients from three NH’s with SNFs,

two NH’s without SNF’s and 10 AL’s. There were an overall group average

of 41 SNF, 145 NH and 97 AL patients respectively during the study period.

Data were collected by the central call center at the time of each call regard-

ing the time, day, nursing facility, reason for the call, and any orders given.

The relationships between the characteristics of the telephone calls and

the type of facility and call time were then analyzed.

Results: There were a total of 1,165 calls placed during the 210 day study pe-

riod from March 11 until October 1, 2009 from three identified types of facil-

ities. The overall number of after hours calls was 798 for SNFs, 327 without

SNFs and 40 from the Assisted Living sites. Calls from the NH’s with SNF’s

were significantly more frequent (19.5 calls/pt) than either the NH without

SNF’s (2.26 calls/pt) or the AL group (0.41 calls/pt). The number of Monday-

Thursday night calls was 553 (47.5%) while the number of Friday night to

Monday morning calls were 612 (52.5%). Most calls were for orders or noti-

fication of laboratory/radiograph results although new admission calls in-

creased from Friday night through Saturday.

Conclusion/Discussion: Our results indicate that patients in nursing facili-

ties generate significant more calls than those with SNF’s or from AL’s. These

calls seem to cluster from Friday night through Saturday reflecting new SNF

admissions from hospital discharges. Focused programs emphasizing daytime

transfers may improve after hours call volume as well as patient care.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

An Action-Based Approach to Improving Pain Management in LongTerm Care

Presenting Author: Sharon Kaasalainen, PhD, McMaster University

Author(s): Sharon Kaasalainen, PhD

Introduction/Objective: Pain management for older adults in long-term care

(LTC) has been recognized as a national and international problem. Un-

treated pain can lead to depression, loneliness, impaired mobility, sleep dis-

turbances, and decreased quality of life. The purpose of this study was to

develop an interdisciplinary approach to improve pain management in

long-term care (LTC) in light of the barriers and facilitators that exist within

the current system.

Design/Methodology: We used a case study approach based on a concurrent

mixed model design that included both qualitative and quantitative components.

Environmental scans were conducted at two LTC sites. Data was collected via fo-

cus groups and interviews with key stakeholders across all health care provider

groups, and administration. In addition, a document review and a short survey

were conducted to assess the perceptions of barriers related to pain management.

Results: The environmental scan findings revealed many barriers to effective

pain management in LTC, including those at the resident/family level (i.e.,

challenges in reporting pain, family concerns, need for individualized pain

treatments); health care provider level (i.e., challenges in assessing pain, re-

luctance to use pain medications, lack of knowledge, lack of communication

across care provider groups, lack of continuity of care); and system level (i.e.,

inadequate accreditation and compliance standards for governing bodies,

lack of support and resources for staff in changing practice, lack of strong lead-

ership to implement change). Based on these findings, a multi-tiered model

was developed with proposed interventions to address these barriers.

Conclusion/Discussion: This model can be used to align and guide the devel-

opment of innovative approaches to improving pain management in LTC

settings, with the ultimate goal of improving pain management services

across all levels of care.

Disclosures: Sharon Kaasalainen, PhD has stated there are no disclosures to

be made that are pertinent to this abstract.

An Important Requisite for Personalized Health Services from theU-care Project for the Aged: A Questionnaire Survey

Presenting Author: Chih-Ming Lin, Dr, Chang Gung Memorial Hospital,

Chang Gung Health and Culture Village

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