title: Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results.
abstract: BACKGROUND
  To better meet the needs of older adults in the emergency department, Senior Friendly care processes, such as high-risk screening are recommended. The identification of Seniors at Risk (ISAR) tool is a 6-item validated screening tool for identifying elderly patients at risk of the adverse outcomes post-ED visit. This paper describes the implementation of the tool in the Mount Sinai Hospital emergency department using a Plan-Do-Study-Act model; and demonstrates whether the tool predicts adverse outcomes.
  
  
  METHODS
  An observational study tracked tool implementation. A retrospective chart audit was completed to collect data about elderly ED patients during 2 time periods in 2010 and 2011. Data analysis compared the characteristics of patients with positive and negative screening tool results.
  
  
  RESULTS
  The identification of Seniors at Risk tool was completed for 51.6% of eligible patients, with 61.2% of patients having a positive result. Patients with positive screening results were more likely to be over age 79 (P = .003); be admitted to hospital (P < .001); have a longer mean ED length of stay (P < .001). For patients admitted to hospital, those with positive screening results had a longer mean inpatient stay (P = .012).
  
  
  CONCLUSIONS
  Implementing the Idenfitication of Seniors at Risk tool was challenged by problematic compliance with tool completion. Strategies to address this included tool adaptation; and providing staff with knowledge of ED and inpatient geriatric resources and feedback on completion rates. Positive screening results predicted adverse outcomes in elderly Mount Sinai Hospital ED patients.
authors.affiliation: Toronto, Ontario, Canada. Electronic address: Nasomaning@mtsinai.on.ca.
authors.forename: Nana
authors.initials: N
authors.lastname: Asomaning
authors.affiliation: Toronto, Ontario, Canada.
authors.forename: Carla
authors.initials: C
authors.lastname: Loftus
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016294:Models, Nursing; D009864:Ontario; D010347:Patient Care Planning; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: Aged; Emergency service; Geriatric assessment; Hospital; Reproducibility of results; Risk assessment; Screening; Sensitivity; Specificity