The PEAGE Study: Patient Experience After Geriatric Evaluation.
Conference Proceeding - Restricted Access
Annals of Emergency Medicine
Study ObjectivesBased on United States (US) Census data, by 2030 the geriatric population (adults aged 65 and older) is expected to be 20% of the population. Currently there are 46 million older adults in the US, and this is projected to reach 90 million by 2050. As the population of the US ages, the population of patients evaluated in the emergency department (ED) will increase as well. In 2018, the American College of Emergency Physicians (ACEP) began a formal accreditation process for Geriatric Emergency Departments (GED). While working to obtain GED accreditation, Beaumont Royal Oak’s ED developed an intradisciplinary geriatric assessment team that began seeing patients in June 2019. In May 2020, Beaumont Royal Oak achieved Level 2 GED accreditation. Our primary objective was to examine patient experience with a geriatric assessment by our team in the ED and to ascertain if patients would recommend that the program continue to be offered.
MethodsCommunity dwelling patients aged 65 and older who presented to the ED Monday through Friday from 9 AM to 5 PM were screened using the Identifying Seniors at Risk questionnaire. Patients who score 2 or higher have been found to have a higher risk of adverse outcomes (functional decline, hospitalization, readmission, death). These patients then underwent additional evaluation to screen for cognitive dysfunction and delirium, evaluate mobility, determine functional independence, and medication reconciliation. Interventions included establishing care with physical therapy and/or occupational therapy, arranging home care, providing durable medical equipment, or discharge directly to subacute rehabilitation. After the geriatric evaluation was complete, patients were provided with a 6-question written survey independent of their disposition, which was collected prior to the patient leaving the ED. Questions on the survey included ranking their satisfaction with different aspects of the program from 1 (very dissatisfied) to 5 (very satisfied) and patients were provided with an opportunity to write additional comments.
ResultsA total of 258 surveys from November 2020 through May 2021 were analyzed. The average age of respondents was 79 years, with 40% identifying as male. Of the patients who completed the survey, 46.1% were discharged, 34% were admitted, 18% were placed in our observation unit, 1.6% were discharged directly to subacute rehabilitation, and 1 patient left AMA. The average overall rating of the program was 4.59, falling between satisfied (4) and very satisfied (5). The average rating of satisfaction with information provided about the program was 4.6, with the average rating of the explanation of the patient's evaluation results being 4.5. The average rating of instructions of follow up care was 4.5. When patients were asked if they recommend the program should continue, 87% responded. Of those respondents, 99.5% stated yes it should continue.
ConclusionIn this qualitative study, older adults who undergo assessment by the Geriatric Assessment Team are appreciative of the specialized care, and recognize that our program is needed. They recommend that the geriatric emergency medicine program continue. Understanding patient experience is vital to improve the quality of care that an ED provides. As more older adults utilize the healthcare system, this becomes more necessary.
Fisher R, Cameron-Comasco L. The PEAGE study: patient experience after geriatric evaluation. Ann Emerg Med. 2021 Oct;78(4 suppl.):S67-68.
American College of Emergency Physicians Research Forum, Boston, MA, October 25-28, 2021.