This project will implement a two-step protocol for multidisciplinary geriatric assessment in the Emergency Department (ED) and develop a promising researcher into an expert in Implementation Science and Quality Improvement. Candidate: Dr. Lauren Southerland is a Geriatric- and Emergency Medicine-trained physician at The Ohio State University Wexner Medical Center (OSU). She designed and leads the first accredited Level 1 Geriatric ED in the Midwest and has prior research on the care of older adults in the ED and in ED Observation Units. Training: The career development plan will build upon Dr. Southerland's unique fellowship training in Geriatric Emergency Medicine with courses in Implementation and Dissemination Science, a Black Belt in Lean Six Sigma, and training in study design, research ethics, and statistics through Master's in Public Health courses. This combination will position her as an expert in Implementation research, with the career goal of translating validated, effective elements of geriatric care into the day to day practice of Emergency Medicine. Mentors/Environment: Dr. Southerland has an experienced mentorship team who will provide guidance in the intricacies of emergency research (Dr. Jeffrey Caterino, MD, MPH primary mentor), implementation strategies and studies of hospital staff and nurses (Dr. Lorraine Mion, PhD), implementation frameworks and reporting (Dr. Christopher Carpenter, an EM physician at Washington University at St. Louis), and identifying environmental and human factor barriers to high quality care (Dr. Susan Moffatt-Bruce, MD, MPH, a vascular surgeon, researcher, and Executive Director of OSU Hospital). Project: Multidisciplinary assessment by geriatricians, physical therapists, case managers, and pharmacists identifies and addresses underlying geriatric issues in older ED patients. However, only a few EDs across the country have been able to incorporate multidisciplinary care for their older patients, due to barriers such as personnel costs, work flow culture, and the 24 hour ED care model. We have developed a two-step protocol to address these barriers: Step 1 is ED nurses using quick, sensitive screens for fall risk (4 Stage Balance Test), delirium (Brief Delirium Triage Screen), and frailty (Identifying Seniors at Risk Score). Patients with concerning results will be placed in an ED Observation Unit for (step 2) multidisciplinary geriatric assessment. Using an ED Observation Unit for these extended assessments overcomes many of the previously identified barriers to multidisciplinary geriatric assessment.
In Aim 1 we will use the Consolidated Framework for Implementation Research and Lean Six Sigma methods to identify and address residual barriers to full implementation.
Aim 2 will evaluate the effectiveness of this protocol in regards to patient-oriented outcomes (functional status and health-related quality of life at 90 days). By using implementation frameworks and processes, we will develop a protocol that is effective, sustainable, adapted to ED culture and work flow, and ready for dissemination to EDs across the US.
Older patients in the Emergency Department frequently experience poor outcomes due to lack of recognition of underlying syndromes, such as delirium, polypharmacy, falls, and social needs. We propose to use rigorous implementation science processes to implement and investigate an ED protocol to screen older adults for these syndromes and address them with multidisciplinary geriatric assessments in an ED Observation Unit. Using an Observation Unit to evaluate older adult patients at risk is a novel strategy developed to address the current barriers of sustainability, cost, and timeliness that arose in prior studies of geriatric assessments in an ED setting.
