Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review.
Cameron J Gettel, Jason R Falvey, Angela Gifford and 4 others
PMID 35247358WHAT IT FOUND
Few tested emergency department discharge programs for older adults with cognitive impairment were found.
Among programs tracking return to the emergency department, all reported fewer visits, but details and patient-centered outcomes were inconsistent.
Key findings
01The review found seven intervention studies with over 2500 participants, but the interventions varied widely.
02Among studies that used emergency department revisits as a primary outcome, all showed a decline in revisit rates after the intervention compared with usual care or the earlier period.
03Patients and care partners identified medication education, care partner involvement, communication, functional independence, home safety, costs, and fear of falling as important transition outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The review covered only emergency department discharge to community settings, not transfers or admissions to hospital. The included studies were heterogeneous in intervention content, setting, personnel, and intensity, and intensity was often poorly described. The review did not assess the quality of the included studies. Only two intervention studies specifically targeted cognitively impaired emergency department patients, and participation rates among people with cognitive impairment varied from 3% to 100%. No study reported participants' race or ethnicity. Screening agreement between reviewers was weak.
Declared interests
The supplied text does not include a funding or conflicts declaration. The listed publication types include NIH and U.S. government research support.
The easy way to misread this
Do not conclude that emergency department discharge interventions are proven to improve outcomes for patients with cognitive impairment. The review found few heterogeneous studies, did not assess study quality, and most patient-centered outcomes were not measured.