Developing a quality framework for the care of older patients in the Emergency Department.

Develop a set of QIs that are both relevant and feasible in the Australian emergency department setting.

Grant ID: PROJ-2010-020-BURKETT-QI

Project Summary

Over the next 20 years there is expected to be a burgeoning in the number of people aged ≥ 70 years in Australia. This rapid aging of our population is expected to result in a marked increase in elderly patient presentations to Emergency Departments. Elderly patients have complex care needs that are highly time- and resource-intensive. In addition, the elderly more commonly have poor outcomes after discharge from emergency, with higher rates of missed diagnoses and medication errors. However, survival and health outcomes of elderly have been shown to improve with high quality care. Quality indicators (QIs) are tools that allow levels of performance to be measured and, as part of a quality management system, provide opportunity for improving care delivery.

This project aims to develop a set of QIs that are both relevant and feasible in the Australian emergency department setting, by means of the following 3 phases:
1. Defining best practice in terms of emergency department care of the older patient via a detailed, systematic search of the scientific literature. An expert panel including emergency medicine specialists, geriatricians, nursing, allied health staff and academics will then develop a set of potential indicators of quality care for this patient group.
2. The candidate indicators will be field tested in eight Australian sites and assessed for their measurability, cost and ability to correctly identify quality of care delivered (in terms of environment, processes of care and outcomes achieved).
3. Finally, the expert panel will review findings of the field-testing and decide on the final set of indicators through a consensus process.

The result of this project will be a set of QIs that will be able to be utilised to allow comparison across centres and optimization of emergency care delivered to the ever-increasing elderly population.

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Outcomes

When piloted, the Quality Indicators (QIs) developed in this project were shown to have the additional benefit of a 31.17% reduction in emergency department presentations of frail patients from residential aged care facilities.

The research formed the basis of the revised Australasian College for Emergency Medicine (ACEM) policy for care of older persons in emergency departments.

In addition, Dr Burkett’s research also led to a $3.7 million grant from Queensland Health in 2014 – and a further $2.9 million in 2016-17 – to develop the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program.

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IMPACT

This program is helping to define best practice in the acute care of the elderly in residential facilities.

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Leveraged Funds

- $3.7 million grant from Queensland Health in 2014

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Dissemination

Journal Articles:

Burkett, E., Martin‐Khan, M.G. and Gray, L.C., 2017. Quality indicators in the care of older persons in the emergency department: a systematic review of the literature. Australasian journal on ageing, 36(4), pp.286-298.

Schnitker, L.M., Beattie, E.R., Martin-Khan, M., Burkett, E. and Gray, L.C., 2016. Characteristics of older people with cognitive impairment attending emergency departments: a descriptive study. Australasian Emergency Nursing Journal, 19(2), pp.118-126.

Burkett, E., Martin-Khan, M.G., Scott, J., Samanta, M. and Gray, L.C., 2016. Trends and predicted trends in presentations of older people to Australian emergency departments: effects of demand growth, population aging and climate change. Australian Health Review, 41(3), pp.246-253.

Schnitker, L.M., Martin‐Khan, M., Burkett, E., Brand, C.A., Beattie, E.R., Jones, R.N., Gray, L.C. and Research Collaboration for Quality Care of Older Persons: Emergency Care Panel, 2015. Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments. Academic Emergency Medicine, 22(3), pp.273-284.

Schnitker, L.M., Martin-Khan, M., Burkett, E., Beattie, E.R. and Gray, L.C., 2013. Appraisal of the quality of care of older adults with cognitive impairment in the emergency department. Journal of gerontological nursing, 39(3), pp.34-40.

Martin-Khan, M., Burkett, E., Schnitker, L., Jones, R.N. and Gray, L.C., 2013. Methodology for developing quality indicators for the care of older people in the Emergency Department. BMC emergency medicine, 13(1), pp.1-11.

Conference Presentations:

Burkett E, Martin - Khan M, Gray L. Environment focused Structural Quality Indicators for the Care of Older ED Patients. PAH Health Symposium; TRI Auditorium, PA Hospital, Woolloongabba, Queensland, Australia2015, August 4-7.

Schnitker, L., M. Martin–Khan, E. Beattie, and L. Gray. Adverse outcomes in older persons presenting to the emergency department: A systematic literature review. in Emerging Researchers in Ageing Conference – ERA 2010. 2010, October 21-22. The University of Newcastle, NSW.

Schnitker, L., M. Martin - Khan, E. Burkett, K. Klein, E. Beattie, and L. Gray. Quality of care of older people with cognitive impairment presenting to emergency departments, the EDQ-CARE study. in National Dementia Research Forum 2011 2011, September 21-23. Wesley Conference Centre, Sydney, NSW.

Schnitker, L., M. Martin–Khan, E. Beattie, and L. Gray, Adverse outcomes and events in older persons presenting to the emergency department: A systematic literature review, in National Dementia Research Forum. 2010, September 23-24: Holiday Inn, Surfers Paradise, Australia.

Schnitker, L., M. Martin - Khan, E. Burkett, E. Beattie, and L. Gray, Evaluating quality of care of older cognitively impaired ED patients, in 20th International Association of Gerontology and Geriatrics (IAGG) World Congress of Gerontology and Geriatrics. 2013, June 23 – 27: Seoul Coex Convention Center, Seoul, South Korea.

Schnitker, L., M. Martin - Khan, E. Beattie, and L. Gray, Evaluating quality of care of older cognitively impaired ED patients, in 45th Australian Association of Gerontology National Conference 2012, November 20-23: Brisbane, Australia.

Schnitker, L., M. Martin - Khan, E. Beattie, and L. Gray, Appraisal of the quality of care in older people with cognitive impairment presenting to emergency departments, in 11th National Conference of Emerging Researchers in Ageing 2012, November: Brisbane, Australia.

Poster Presentations:

Schnitker, L., M. Martin–Khan, E. Beattie, and L. Gray. Adverse outcomes in older persons presenting to the emergency department: A systematic literature review. in PAH Week 2010 - Leading Health in a Changing World. 2010, August 16-20. Princess Alexandra Hospital, Woolloongabba, QLD.

Schnitker, L., M. Martin–Khan, E. Beattie, and L. Gray, Adverse outcomes and events in older ED patients: A systematic review, in 20th International Association of Gerontology and Geriatrics (IAGG) World Congress of Gerontology and Geriatrics. 2013, June 23 – 27: Seoul Coex Convention Center, Seoul, South Korea.

Schnitker, L., M. Martin–Khan, E. Beattie, and L. Gray, Adverse outcomes and events in older ED patients: A review, in 45th Australian Association of Gerontology National Conference. 2012, November 20-23: Brisbane, Australia.

Schnitker, L., M. Martin - Khan, E. Burkett, K. Klein, E. Beattie, and L. Gray, Quality of Care of Older People with Cognitive Impairment Presenting to Emergency Departments, The EDQ-Care Study, in PAH Week. 2012, August.

Schnitker, L., M. Martin - Khan, E. Burkett, K. Klein, E. Beattie, and L. Gray. Quality of care of older people with cognitive impairment presenting to emergency departments, the EDQ-CARE study. in National Dementia Research Forum 2011 2011, September 21-23. Wesley Conference Centre, Sydney, NSW.

Schnitker, L., M. Martin - Khan, E. Burkett, K. Klein, E. Beattie, and L. Gray, Quality of Care of Older People with Cognitive Impairment Presenting to Emergency Departments, The EDQ-Care Study, in PAH Week 2011. 2011, September 6-9.

Schnitker, L., M. Martin - Khan, E. Burkett, K. Klein, E. Beattie, and L. Gray, Quality of Care of Older People with Cognitive Impairment Presenting to Emergency Departments, The EDQ-Care Study, in Ninth Asia/Oceania Congress of Geriatrics and Gerontology. 2011, October 23-27: Melbourne Australia.

Schnitker, L., M. Martin - Khan, E. Beattie, and L. Gray. Best practice potentials for the management of older people with cognitive impairment presenting to emergency departments: a systematic review. in 20th International Association of Gerontology and Geriatrics (IAGG) World Congress of Gerontology and Geriatrics. 2013, June 23 – 27. Seoul Coex Convention Center, Seoul, South Korea.

Schnitker L, Martin - Khan M, Burkett E, Beattie E, Gray L. Quality indicators for the care of older ED patients with cognitive impairment. 2015 Alzheimer's Association International Conference; Walter E. Washington Convention Center, Washington DC, United States2015, July 18-23.

Schnitker L, Martin-Khan M, Burkett E, Beattie E, Gray L, editors. Quality Indicators for the Care of Older ED Patients with Cognitive Impairment. PAH Health Symposium; 2015, August 4-7; TRI Auditorium, PA Hospital, Woolloongabba, Queensland, Australia.

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