174 Chapter 8 we were not able to present a definite recommendation for EDs to implement a specific intervention to alleviate ED crowding. In chapter 4, we presented the results of our nationwide online survey among all emergency physicians in the Netherlands, which assessed and explored the educational needs of emergency physicians regarding geriatric emergency medicine, factors determining these educational needs, and the utilization of geriatric emergency medicine education by emergency physicians. We also presented the results of a second nationwide online survey among ED managers in the Netherlands, which aimed to assess and explore ED managers’ views on geriatric emergency medicine and recognition for geriatric emergency medicine education by ED managers. The results of the first survey showed that a large proportion of emergency physicians in the Netherlands felt unprepared for the care of older adults in the ED; emergency physicians reported needing more skills in all geriatric competency domains. Our results also showed that only a minority of hospitals organized geriatric education for emergency physicians and that emergency physicians rarely utilized geriatric education outside their own hospital. The results of the second survey showed that a vast majority of ED managers considered care for older adults an important topic. However, a lack of time and finances were major obstacles for managers to organize geriatric emergency medicine for emergency physicians. Chapter 5 reported the introduction and evaluation of a geriatric education program for emergency physicians. The education program was a combination of an online training module and lectures. We used a mixed methods study to quantitatively evaluate the effects of the education program on emergency physicians’ knowledge, attitudes and medical practice and qualitatively gain insight into the experiences and effects of the program. The results showed that the education program significantly improved emergency physicians’ knowledge of geriatric emergency medicine. The attitude of emergency physicians towards older adults did not significantly change after the education program. Evaluation of emergency physicians’ medical practice showed significantly more attention to patients’ social circumstances. Emergency physicians described mainly positive experiences with the program and indicated that the program improved their ability to recognize frailty and geriatric syndromes. In chapter 6, we evaluated the effects of teach-back at ED discharge on ED revisits and the clinical outcomes of older adults in the ED. The teach-back method was introduced and taught to ED nurses and physicians before the start of the study. A pre-post evaluation of older adults in the ED discharged with the use of teach-back was performed. We found positive associations between the use of teach-back and a reduction in ED revisits of older adults discharged from the ED. Older adults discharged from the ED with the use of teach-back had
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