Leveraging VA Geriatric Emergency Department Accreditation to Improve Elder Abuse Detection in Older Veterans using a Standardized Tool.
Lena K MakarounJaime J HalaszynskiTony E RosenKristin Lees HaggertyJennifer K BlatnikRuthann FrobergAlyssa ElmanChristine A GearyDyan M HagyCrescencio RodriguezColleen M McQuownPublished in: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2022)
Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA Emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs, former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center (LSCVAMC) Geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record (EHR) and GED workflow in December 2020. By July 2022, 251 Veterans were screened with 9 (3.6%) positive on the prescreen and 5 (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and non-licensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.
Keyphrases
- healthcare
- emergency department
- quality improvement
- palliative care
- electronic health record
- mental health
- community dwelling
- middle aged
- physical activity
- public health
- primary care
- hip fracture
- high throughput
- liver failure
- social media
- extracorporeal membrane oxygenation
- human health
- risk assessment
- single cell
- affordable care act
- clinical decision support