Toward patient-centered care: a systematic review of older adults' views of quality emergency care.
OBJECTIVE
Observers have cited a quality gap between the current emergency care and the needs of elderly adults in the emergency setting. The Institute of Medicine identified patient-centeredness as a vital aim of quality health care. To develop a patient-centered approach in the emergency setting, we must first understand the elderly patients' views of their emergency care. Thus, we performed a systematic review to synthesize the current knowledge about the elderly patient's preferences and views of their emergency care.


METHODS
Systematic review of qualitative studies and surveys addressing the elderly patients' views of their emergency care using PUBMED and CINAHL. Using meta-ethnography, we identified 6 broad themes about the elderly's perspectives of hospital-based emergency care.


RESULTS
Of the 81 articles initially identified, our final review included 28 articles. We developed 6 themes of quality emergency care: (1) role of health care providers; (2) content of communication and patient education; (3) barriers to communication; (4) wait times; (5) physical needs in the emergency care setting; and (6) general elder care needs. Key findings were that emergency staff should (1) assume a leadership role with both the medical and social needs; (2) initiate communication frequently; (3) minimize potential barriers to communication; (4) check on patients during prolonged periods of waiting; (5) attend to distress caused by physical discomforts in the emergency care setting; and (6) address general elder care needs, including the care transition and involvement of caregivers when necessary.


CONCLUSIONS
Current qualitative research on the views of the elderly patient to hospital-based emergency care reveals common themes that should be considered in efforts to improve delivery of care to the elderly patient.
Department of Emergency Medicine, Boston Medical Center, Boston, MA. Electronic address: kns1@bu.edu.
Kalpana N
KN
Shankar
Rush Medical College, Chicago, IL.
Bhavnit K
BK
Bhatia
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
Jeremiah D
JD
Schuur
D000368:Aged; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D011787:Quality of Health Care