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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
4
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: [email protected]
Twitter: @BlomaardLC