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The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method
Journal article   Peer reviewed

The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method

Andrea Taylor, Marc Broadbent, Apil Gurung and Marianne Wallis
International emergency nursing, Vol.55, 100847
2021
DOI: https://doi.org/10.1016/j.ienj.2020.100847
PMID: 32205108

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Abstract

Geriatric assessment Aged Emergency service, hospital Consensus process
•CGA in the ED is considered useful for older adults yet is difficult to complete.•A RAND/UCLA consensus methodology has been applied to develop a unique CGA for ED use.•The CGA satisfies the unique work-flow conditions found in the ED. The universal screening and comprehensive assessment of older persons presenting to the emergency department is considered useful, yet is difficult to embed. A number of assessment instruments exist however they are not widely used and there is a lack of agreement between clinicians as to which tools are best suited to the emergency department. The aim of this study was to develop a modified comprehensive geriatric assessment using consensus methodology for use by the multidisciplinary team in the emergency department. The modified comprehensive geriatric assessment was formulated using the RAND/UCLA appropriateness methodology incorporating consensus opinion from an expert group of clinicians and the best scientific evidence available. A series of pre and post survey and expert group meetings were held with expert multidisciplinary clinicians. Emphasis was placed on a pragmatic approach to the development of a document which reflected consensus opinion. Between nine and 15 expert group members participated in the stages of the process. A tiered approach incorporating different aspects of screening and/or assessments was considered optimal to reflect the stages of decision-making in the emergency department process. A unique approach to the screening and assessment of the frail older person was developed using consensus methodology to develop a modified comprehensive geriatric assessment for use in the emergency department. Associated actions and interventions are an important next step, with pilot site testing.

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