title: Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.
abstract: OBJECTIVE
  The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs).
  
  
  METHODS
  A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria.
  
  
  RESULTS
  At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients' delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment.
  
  
  CONCLUSIONS
  This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.
authors.affiliation: The Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Schnitker
authors.forename: Melinda
authors.initials: M
authors.lastname: Martin-Khan
authors.forename: Ellen
authors.initials: E
authors.lastname: Burkett
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Brand
authors.forename: Elizabeth R A
authors.initials: ER
authors.lastname: Beattie
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.forename: Len C
authors.initials: LC
authors.lastname: Gray
mesh_terms: D000368:Aged; D017028:Caregivers; D003072:Cognition Disorders / Q000628:therapy*; D003693:Delirium / Q000175:diagnosis*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D057766:Policy; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration; D012307:Risk Factors