Use of the Electronic Medical Record to screen for high-risk geriatric patients in the Emergency Department

Introduction
Older adults with multi-morbidities have the highest rate of ED usage. These patients are typically on numerous medications, may have underlying dementia, and often present with falls and delirium. Identifying these high-risk older adults for possible intervention is challenging in the ED setting since available screening methods are manual and resource-intensive. The objective is to study the feasibility of using the Electronic Medical Record (EMR) for identifying high-risk older adults in Emergency Department (ED).
Study Setting
Academic ED with 67,000 total and 24% geriatric (age ≥ 65 years) annual visits, American College of Emergency Physician (ACEP) accredited Level 1 Geriatric Emergency Department with ED-based geriatric consultation program.
Materials and Methods
This is a feasibility study incorporating criteria from existing manual geriatric screening instruments and the 4M framework into an automated EMR screen to identify high-risk geriatric patients. ED provide..., This was a descriptive feasibility study of the use of EMR screening for high-risk older patients in the setting of a busy urban academic American College of Emergency Physician (ACEP)-accredited Level 1 Geriatric Emergency Department with an ED-based geriatric consult program, and 67 000 total annual visits, with 24% geriatric (age ≥ 65) years visits conducted from March 31, 2020, to May 31, 2020.
Subject matter experts from Emergency Medicine, Geriatric Medicine, Nursing, Pharmacy, Case Management, and Social Work used a modified Delphi method, based on review of the literature and professional judgment, to develop criteria to define high-risk geriatric characteristics which can be captured by the EMR.
Prior to EMR screening implementation, ED providers were educated on 8 geriatric domains using case series and CME modules and patients aged 65 years and older were screened for delirium at the time of triage using the 4AT delirium screen. The 4AT is a brief delirium screening tool with..., Please see README document and accompanying published article.
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