title: Identification of seniors at risk: process evaluation of a screening and referral program for patients aged > or =75 in a community hospital emergency department.
abstract: Reports on the authors' experience with a patient safety quality improvement program, intended to reduce the incidence and severity of adverse outcomes for emergency department (ED) patients aged > or = 75. The Identification of Seniors at Risk scale was used for screening, and those at high risk were referred for appropriate intervention. The plan-do-study-act improvement cycle was followed, conducting process evaluation to diagnose and correct implementation difficulties. Reports that: implementing an ED screening and referral program is deceptively difficult; process evaluation multidisciplinary working group meetings are an essential improvement tool; screening inclusion criteria had to be adapted to the subject population in order to make efficient use of staff time; the screening questions and process required ongoing assessment, revision, and local adaptation in order to be useful; and high-risk screening in the ED is critical to a hospital system's ability to anticipate clinical problems; the plan-do-study-act improvement cycle is a practical and useful tool for improving quality and systems in a real care setting.
authors.affiliation: School of Public Administration, University of Victoria, Victoria, Canada.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Warburton
authors.forename: Belinda
authors.initials: B
authors.lastname: Parke
authors.forename: Wynona
authors.initials: W
authors.lastname: Church
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D002170:Canada; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000592:standards*; D015577:Geriatric Assessment; D005851:Geriatric Nursing; D006299:Health Services for the Aged / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D008403:Mass Screening; D010343:Patient Admission; D015397:Program Evaluation; D012017:Referral and Consultation; D018570:Risk Assessment; D017749:Total Quality Management / Q000379:methods*; D014218:Triage