Safer Care for Older People in the Emergency Department

Background The number of over 75-year-old patients (O75YOs) presenting to our Emergency Department (ED) has increased by 35% since 2020 and continues to rise. It is well documented that older people present more frequently to EDs with a higher level of illness severity, a higher rate of admission or re-attendance and are at a greater risk of adverse outcomes such as falls, delirium, prolonged ED and/or hospital stay and ultimately mortality (Tan et al. 2012). We developed a safety huddle to identify and reduce risks to older people in our ED with a view to improving their outcomes. Methods Our 10-minute huddle took place each day at 3pm (peak occupation time of O75YOs). An ED physician, nurse, AHP and Geriatrician/Registrar were required to attend. The huddle script was developed based on feedback from clinicians and a literature review on risks associated with an ED presentation in older adults. The script focused on recording resourcing issues critical to patient care. The primary risk factors recorded included falls risk, delirium, administration of time critical medications and PET times. Following the huddle, HCPs involved in the patient’s care were updated by the relevant member of the MDT in attendance to ensure agreed interventions were completed/in place. Results We observed a decrease in the number of falls from 2 to 0. Delirium screening improved from 0% to 26%. Identification and administration of time critical medications improved from 0% to 78%. PET times increased slightly (2%), however admission rates decreased indicating value added to the patients’ journey. Conclusion Whilst we acknowledge there is still room for improvement, these results will clearly have a positive impact on patient outcomes.