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Toward Patient-Centered Care: A Systematic Review of Older Adults’ Views of Quality Emergency Care - 18/04/14

Doi : 10.1016/j.annemergmed.2013.07.509 
Kalpana N. Shankar, MD, MSc a, , Bhavnit K. Bhatia, BA b, Jeremiah D. Schuur, MD, MHS c
a Department of Emergency Medicine, Boston Medical Center, Boston, MA 
b Rush Medical College, Chicago, IL 
c Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 

Corresponding Author.

Abstract

Study objective

Observers have cited a quality gap between the current emergency care and the needs of elderly adults in the emergency setting. The Institute of Medicine identified patient-centeredness as a vital aim of quality health care. To develop a patient-centered approach in the emergency setting, we must first understand the elderly patients’ views of their emergency care. Thus, we performed a systematic review to synthesize the current knowledge about the elderly patient’s preferences and views of their emergency care.

Methods

Systematic review of qualitative studies and surveys addressing the elderly patients’ views of their emergency care using PUBMED and CINAHL. Using meta-ethnography, we identified 6 broad themes about the elderly’s perspectives of hospital-based emergency care.

Results

Of the 81 articles initially identified, our final review included 28 articles. We developed 6 themes of quality emergency care: (1) role of health care providers; (2) content of communication and patient education; (3) barriers to communication; (4) wait times; (5) physical needs in the emergency care setting; and (6) general elder care needs. Key findings were that emergency staff should (1) assume a leadership role with both the medical and social needs; (2) initiate communication frequently; (3) minimize potential barriers to communication; (4) check on patients during prolonged periods of waiting; (5) attend to distress caused by physical discomforts in the emergency care setting; and (6) address general elder care needs, including the care transition and involvement of caregivers when necessary.

Conclusion

Current qualitative research on the views of the elderly patient to hospital-based emergency care reveals common themes that should be considered in efforts to improve delivery of care to the elderly patient.

Le texte complet de cet article est disponible en PDF.

Plan


 Supervising editor: Timothy F. Platts-Mills, MD
 Author contributions: JDS conceived the study and developed the initial inclusion and exclusion criteria. BKB undertook the initial literature review. KNS and JDS undertook the review of articles included to develop the final list of articles included and excluded in the study and provided the statistical advice to determine agreement on articles. KNS and BKB drafted the article, and all authors contributed substantially to its revision. KNS takes responsibility for the paper as a whole.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: Dr. Schuur was funded by a Jahnigen Career development award funded by the Atlantic Philanthropies and the American Geriatrics Society.
 Please see page 530 for the Editor's Capsule Summary of this article.
 A podcast for this article is available at www.annemergmed.com.


© 2013  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 63 - N° 5

P. 529 - mai 2014 Retour au numéro
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