Assessing what matters most in older emergency department patients

BACKGROUND: Older emergency patients have complex health needs and diverse personal priorities not captured by traditional single-disease approaches. Asking 'what matters most' may facilitate a more patient-centred approach. However, conceptual frameworks to document patient values have neither been implemented nor operationalised for use in the emergency department (ED). OBJECTIVE: To investigate the feasibility of asking 'what matters most' in the ED, assess patient priorities and determine the utility of a conceptual framework for documenting these. METHODS: Prospective, observational study in a Swiss ED with consecutive patients aged ≥65 years. Feasibility was determined as proportion of included patients to eligible patients. Patient responses were categorised using a conceptual framework consisting of 8 domains: principles, relationships, emotions, activities, abilities, possessions, medical and others. Framework evaluation included interrater reliability (IRR), time-to-abstraction rate and a questionnaire assessing utility of the framework. RESULTS: Asking what 'matters most' was feasible, including 1349 of 1625 patients (83.0%). Regarding categories of the conceptual framework, 504 patients (37.4%) reported medical issues, 297 (22.0%) relationships, 268 (19.9%) abilities and 154 (11.4%) emotions as their priority. Patients aged ≥85 years or having frailty more frequently prioritised abilities and emotions, whereas patients 65-84 years or without frailty prioritised medical issues. The framework showed substantial IRR (κ = 0.668), good time-to-abstraction rates and high ratings in the utility questionnaire. CONCLUSIONS: Asking older people 'what matters most' is feasible and potentially useful in the ED setting. Applying a conceptual framework enables systematic documentation and may support patient-centred and holistic emergency care.