Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research.
Objective: Implementation of evidence‐based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real‐world use of theory‐based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening pro...
| Publicado en: | Academic Emergency Medicine Vol. 30; no. 11; pp. 1117 - 1129 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=173587078&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 173587078 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10696563 Z27 jtl: Academic Emergency Medicine issn: 10696563 maglogo: Y pubinfo: dt: Nov2023 vid: 30 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 173587078 173587078 173587078 10.1111/acem.14776 173587078 ppf: 1117 ppct: 12 formats: tig: atl: Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research. aug: au: Southerland, Lauren T. Gulker, Peg Van Fossen, Jenifer Rine‐Haghiri, Lorri Caterino, Jeffrey M. Mion, Lorraine C. Carpenter, Christopher R. Cardone, Michael S. Hill, Michael Hunold, Katherine M. affil: Department of Emergency Medicine, The Ohio State University, Columbus Ohio,, USA sug: subj: Geriatric Assessment Health Screening Nursing Practice, Evidence-Based Gerontologic Nursing Emergency Service Implementation Science Human Scales Clinical Assessment Tools Delirium Diagnosis Triage Accidental Falls Risk Factors Risk Assessment Vulnerability Evaluation Aged Descriptive Statistics Self-Efficacy Organizational Culture Referral and Consultation Social Workers Physicians Tertiary Health Care Academic Medical Centers Conceptual Framework Geriatric Functional Assessment COVID-19 Pandemic Emergency Nursing Funding Source Aged: 65+ years ab: Objective: Implementation of evidence‐based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real‐world use of theory‐based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening program in the ED using the Consolidated Framework for Implementation Research (CFIR). Methods: The EBP involved nurses screening older patients for delirium (Delirium Triage Screen), fall risk (4‐Stage Balance Test), and vulnerability (Identification of Seniors at Risk score) with subsequent appropriate referrals to physicians, therapy specialists, or social workers. The proportions of screened adults ≥65 years old were tracked monthly. Outcomes are reported January 2021–December 2022. Barriers encountered were classified according to CFIR. Implementation strategies were classified according to the CFIR‐Expert Recommendations for Implementing Change (ERIC). Results: Implementation strategies increased geriatric screening from 5% to 68%. This did not meet our prespecified goal of 80%. Change was sustained through several COVID‐19 waves. Inner setting barriers included culture and implementation climate. Initially, the ED was treated as a single inner setting, but we found different cultures and uptake between ED units, including night versus day shifts. Characteristics of individuals barriers included high levels of staff turnover in both clinical and administrative roles and very low self‐efficacy from stress and staff turnover. Initial attempts with individualized audit and feedback were not successful in improving self‐efficacy and may have caused moral injury. Adjusting feedback to a team/unit level approach with unitwide stretch goals worked better. Identifying early adopters and conducting on‐shift education increased uptake. Lessons learned regarding ED culture, implementation in interconnected health systems, and rapid cycle process improvement are reported. Conclusions: The pandemic exacerbated barriers to implementation in the ED. Cognizance of a large ED as a sum of smaller units and using the CFIR model resulted in improvements. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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