title: Changes in Emergency Department Geriatric Services in Quebec and Correlates of These Changes.
abstract: OBJECTIVE
  To describe changes in geriatric emergency department (ED) services from 2006 (T1) to 2013/14 (T2), associated factors, and outcomes.
  
  
  METHODS
  Two-wave survey design.
  
  
  METHODS
  Province of Quebec, Canada.
  
  
  METHODS
  Lead nurses and physicians at 57 EDs that participated in both the T1 and T2 surveys.
  
  
  METHODS
  Changes over time in ED geriatric services, observed naturalistically.
  
  
  METHODS
  Survey questionnaires assessed: ED geriatric services (11 items) and nursing and geriatric staffing resources. Key administrative data indicators for ED bed visits for T1 and T2 for ages 75 and over included: volume of ED visits; length of ED stay; admission rate; and 30-day return visits.
  
  
  RESULTS
  There was a significant overall increase in the number ED geriatric services, from mean 2.8 (SD 2.2) at T1 to mean 6.0 (SD 2.0) at T2. EDs were clustered into 3 groups based on their T1 and T2 geriatric service scores: "early adopters" (n = 12); "late adopters" (n = 27); "non-adopters" (n = 18). Group membership was associated with three T1 variables: availability of a geriatric nurse clinician, a lower ratio of nurses to ED beds, and longer ED stays. There were significant overall increases between T1 and T2 in number of ED bed visits and ED length of stay among those aged 75 and over, decreases in hospitalization rates, but no change in ED return visits. There were no differential changes in the key indicators among the three ED clusters.
  
  
  CONCLUSIONS
  Overall, ED geriatric services improved in Quebec from 2006 to 2013/14. EDs with a geriatric nurse clinician, relatively fewer nursing resources, and longer ED stays improved more quickly.
authors.affiliation: St. Mary's Research Centre, Montreal, Canada.|McGill University, Montreal, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.affiliation: Université de Montréal, Montreal, Canada.|Emergency Medicine Services, Montreal Heart Institute, Montreal, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Vadeboncoeur
authors.affiliation: Université de Montréal, Montreal, Canada.|Montreal Heart Institute Research Center, Montreal, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cossette
authors.affiliation: Université de Montréal, Montreal, Canada.|Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Veillette
authors.affiliation: Université de Montréal, Montreal, Canada.|Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada.
authors.forename: Francine
authors.initials: F
authors.lastname: Ducharme
authors.affiliation: Université de Montréal, Montreal, Canada.|Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada.|Centre hospitalier de l'Université de Montréal, Montreal, Canada.
authors.forename: Thien Tuong
authors.initials: TT
authors.lastname: Minh Vu
authors.affiliation: St. Mary's Research Centre, Montreal, Canada.|McGill University, Montreal, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciampi
authors.affiliation: St. Mary's Research Centre, Montreal, Canada.|Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Canada.
authors.forename: Deniz
authors.initials: D
authors.lastname: Cetin-Sahin
authors.affiliation: St. Mary's Research Centre, Montreal, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Belzile
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D005851:Geriatric Nursing / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010359:Patient Readmission; D010820:Physicians / Q000523:psychology; D011787:Quality of Health Care; D011792:Quebec; D011795:Surveys and Questionnaires
keywords: aged; emergency department; length of stay; quality of care