53 Interventions to relieve ED crowding by older adults CHAPTER 3 were implemented in an hospital setting [31, 32, 35-44]. In the other five studies patients were primarily exposed to the intervention in the community, mostly at home [29, 30, 33, 34, 36]. Ten interventions consisted of a geriatrician or geriatric pharmacist embedded within the ED, or ED staff with geriatric expertise to facilitate more efficient and effective care for older adults [29, 32, 33, 37, 38, 40-44]. Ten interventions incorporated case management by multidisciplinary teams that assessed patient-specific needs, provided care strategies and linked patients to necessary services [29, 31,32,33, 35, 38-42]. Ten interventions initiated care and disposition planning by regular ED staff or nurse liaisons to ensure continuity of care after a patient’s discharge from the ED [29, 31-33, 35, 37, 38, 41, 43, 44]. Nine interventions provided post-ED discharge follow-up, mostly through telephone calls by ED nurses [31, 32, 35-37, 43], and by home visits to manage care needs and link patients to required services [29, 30, 33]. Eight interventions included ED-based geriatric assessment to improve a timely recognition and treatment of geriatric problems. Five of the eight interventions consisted of CGA [32, 40-43]. Four interventions were specific units or zones with dedicated space and beds to address the specific emergency needs of older adults [39-42]. Taylor et al. [42], and Conroy et al. [40], created an ‘acute frailty zone’ within the ED – with early access to geriatrician-led multidisciplinary input and CGA – that replaced the pre-existing geriatrician in-reach service. Lee et al. [34], described a portable Personal Emergency Response System (PERS) for patients who recently visited the ED after a fall incident. This intervention did not adhere to any of the intervention core elements. Figure 2 Reviewers’ judgments about each risk of bias item presented as percentages across all included studies Random sequence generation (selection bias) Low risk of bias Unclear risk of bias 0% 25% 50% 75% 100% High risk of bias Allocation concealment (selection bias) Similar baseline outcome measurements Similar baseline characteristics Incomplete outcome data (attrition bias) Blinding of outcome assessment (detection bias) Study protected against contamination Selective reporting (reporting bias) Other bias
RkJQdWJsaXNoZXIy MjY0ODMw