L’amélioration de la prise en charge des personnes âgées dans le service d’urgences de l’Hôpital d’Ixelles-Etterbeek peut-elle être facilitée par une approche structurée en critères de qualité définis via la méthode Delphi?

Details

Supervisors

Maertens de Noordhout, Charline ; Thys, Frédéric

Faculty

Faculté de santé publique

Degree label

Master [120] en sciences de la santé publique

Abstract

Background: The need for health care for the elderly is increasing, due to a population growth of patients over 75 years of age and the long-life expectancy with poly-pathological patients. Emergency services, who often offer poor care options for this demographic, must reconsider their strategy towards seniors. In Belgium, there is a lack of staff trained in the care of geriatric patients, screening tests and assessments of functional or cognitive decline are rarely used and infrastructures are often poorly adapted to optimally care for these often fragile patients. To meet these needs, the objectives of this work were: 1) to development “The Belgian Elder-Friendly Emergency Department Assessment Tool” (The Belgian EFEDAT) to assess the management and care of geriatric patients in emergency departments and 2) to use the Belgian EFEDAT to assess the quality of care for patients over 75 years of age in the emergency department of the Ixelles-Etterbeek Hospital. Methods: A review of the literature made it possible to establish the criteria that should be assessed in the Belgian EFEDAT. The Delphi method was used to adapt and validate the Belgian EFEDAT. A total of three expert rounds and a focus group were conducted to reach a consensus. The Belgian EFEDAT was then distributed to all emergency doctors, emergency nurses and geriatricians of the Ixelles-Etterbeek Hospital to assess the quality of geriatric care within the hospitals’ emergency department. Three quality thresholds (adapted - sensitized - not adapted) have been set to signify the adaptation of emergency services within the Belgian EFEDAT. Results: Seventeen articles from the literature were used to construct the basic Belgian EFEDAT. A total of eighteen experts participated in the Delphi method and seventeen experts validated the Belgian EFEDAT. The evaluation of the emergency department of the Ixelles-Etterbeek Hospital was carried out by twenty-six emergency nurses, eleven emergency doctors, and two geriatricians. The results gained from the assessment highlighted the presence of twenty-four criteria (32.5%) and the absence of forty-four (55.8%). No collective agreement was found for eight of the criteria (10.4%). The result allows us to qualify the emergency department of the Ixelles-Etterbeek Hospital as unsuitable (less than 50% of criteria are present) for the elderly and to affirm that senior’s care isn’t optimal. Conclusion: The use of the Belgian EFEDAT for optimal management of geriatric patients has highlighted weaknesses at the Ixelles-Etterbeek Hospital for aged care, due to a lack of qualified staff in geriatrics, staff training, and coordination of patient dismissal. Solutions to improve support would include the creation of internal protocols and the investment in facilities specifically designed for aged care. We recommend the use of this Belgian Elder-Friendly Emergency Department Assessment Tool to assess aged care in other French speaking emergency services in Belgium.