Improving care for the older ED patient: implementation of a screening program

Laura Blomaard

Department of Internal Medicine – Gerontology & Geriatrics LUMC

Leiden GEM Conference 24-10-2017

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Disclaimer

No conflicts of interest

Financed by:

Question

What words come to mind when thinking of

‘older patients on the ED’?

Introduction

Short screening at triage Emergency Department

Informed treatment decisions

Protective actions/interventions

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Vulnerable? High risk: - functional decline - cognitive impairment

APOP study

Overall aim

to improve care for the acutely presenting older patient

Acutely presenting

older patient

High

risk target

optimal

care

Part 1 Part 2

APOP study

Prospective multicenter cohort study

Inclusion: all ED patients > 70 years, during 12 weeks 24h-7d / 12h-7d

Follow-up: 90 day & 1 year telephone follow-up

Outcome: functional decline, mortality and quality of life

De Gelder et al, Netherlands Journal of Medicine, 2016

APOP screener

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©LaLecq

Screening

Age

Gender

Arrival by ambulance

Need regular help (IADL)

Need help bathing

Hospitalized <6 months

Impaired cognition - dementia yes/no - 2 questions of 6-CIT

Result

Low risk

High risk functional decline

Signs of impaired cognition

High risk on both domains: functional decline and impaired cognition

screener.apop.eu

De Gelder et al, update of APOP screener, 2017 (submitted)

Successful implementation

Get connected

Awareness

Implementation

Part 2

Education

• GEM Conference

• Local education

– Geriatric medicine in acute care

– How to use the APOP screener in practice

– Actions/interventions for high risk patients

• Online e-learning

Awareness

Implementation

User experience

Patients Nurses Doctors

Focusgroups

Questionnaires

Questionnaires

Pilot studies

Questionnaires

‘Implement in EPD’ ‘What to do with the results?’

Implementation

Interventions Implementation

Part 1

Part 2

Research

• Before – after study 3 month periods

• # patients screened

• # patients to receive each intervention

• Factors influencing screening/interventions

Implementation

Future perspectives

Care network

Home

General Practitioners

Emergency Department

Hospital wards

Institutes (revalidation)

(Nursing) home

Home care

Care givers

Outpatient clinic

Paramedics

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Take home messages

Get connected

Awareness

Implementation

Acknowledgements 1

Jacinta Lucke & Jelle de Gelder

Acknowledgements 2

Principle investigator

Simon Mooijaart

LUMC - Emergency department

Jacinta Lucke

Bas de Groot

Anja Booijen

Sjaak van der Linden

Christian Heringhaus

LUMC- Internal medicine (geriatrics / acute medicine)

Jelle de Gelder

Frédérique de Croock

Jaap Fogteloo

Wouter Dannenberg

Marjan van der Elst

LUMC - PHEG

Jacobijn Gussekloo

Alrijne Hospital

Sander Anten

Kanar Mesri

HMC-Bronovo

Gerard-Jan Blauw

Gijs Willemsen

Merel van Loon

Erasmus University Medical Center

Anniek Brink

Ewout Steyerberg

Stephanie Klein Nagelvoort Schuit

Jelmer Alsma

Lots of students!

Questions?

More information

Website: www.apop.eu

Screener: screener.apop.eu

Twitter: @APOPLeiden

Contact

Mail: L.C.Blomaard@lumc.nl

Twitter: @BlomaardLC