Inclusion of family, friends and other informal and formal carers in ED

Why is this important?

Informal and formal carers should be treated as partners in care. The presence of carers by the patient’s side may help reduce the risk of delirium and improve an older patients’ experience in the Emergency Department (ED).^1–3 Informal carers, such as family members and friends, may contribute important patient information, help develop a more holistic care plan, assist with communication and provide emotional support to the patient.⁴ This means that involving carers leads to more tailored discharge planning, which is associated to improved outcomes for the patient and carer (e.g. reduced risk of readmission to the ED).⁵ As carers can play a significant role to help implement recommendations during and after ED care, it is important to consider their views, when devising the care plan. Engagement and co-operation with carers, as well as patients, is an essential part of good patient care.^6,7

How can we involve the patient’s entourage?

• Ask for and note name, relationship and contact details of the key carer(s) in the patient chart upon arrival at the ED. Do this with both accompanied patients as well as with patients who present alone to the ED. (Beware: the key carer might not be the same person who is accompanying the patient to the ED.)
• Where possible, carers should be encouraged to stay alongside the patients during ED stay, as they may contribute to reduce the risks of hospital acquired complications, help integrate the acute episode into longer-term care plans, and assist with hospital-to-home transition.
• When appropriate, include carers in the process of care, especially when treating patients with cognitive impairment.
• NOTE: it is best to limit the number of accompanying carers according to the capacity of the ED. ⁴

For older patients coming from care facilities:

• Map the care facilities around the ED to ensure contact details.
• Discuss at organizational level how patient information (e.g. contact details of key carers, medical information and nursing needs) can be transferred to the ED.
• Decide on the person in the ED who should establish communication channels (social worker, administration, gerontological nurse specialist, other) and smoothen care transitions back and forth.

What should we do?

1. Determine the care needs of the older patient during ED admission. (score basic and instrumental activities of daily living checklists, ADL and IADL^8,9)
2. Determine the level of support required by the patient in the ED and anticipate discharge needs in collaboration with the carers.
3. When possible, assess carer burden and their capacity to carry out instructions.
4. When discharging a patient to an outpatient setting, readily provide information about different forms of support that may be available. Ensure that your teams are able to refer patients and their carers to the necessary services that can provide or organise health and social support.
5. Ensure that the patient (when possible) and their carer clearly understand arrangements related to discharge planning as well as other follow-up instructions.
6. Hospitals should facilitate patient and public involvement in the development of quality improvement strategies aimed at improving patients’ experience in the ED.³

Toolbox

• ADL and IADLs checklist
• Emergency Department Transitions of Care - A Quality Measurement Framework Final Report
• Caring for the Caregiver in the Emergency Department, STAT (blog), 12 February 2018

Information

This education material was developed by the European Task Force for Geriatric Emergency Medicine, which is a collaboration between the European Society for Emergency Medicine (EUSEM) and the European Geriatric Medicine Society (EuGMS). For more information, please visit: geriEMEurope.eu and follow us on Twitter: @geriEMEurope.

References

1. Health and Social Care Scotland. Involving Carers in Discharge Planning A practical guide for health and social care practitioners involved in discharge planning from hospital. [Internet]. 2019 [cité 8 janv 2021].
2. Shé ÉN, Keogan F, McAuliffe E, O’Shea D, McCarthy M, McNamara R, et al. Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway. Int J Environ Res Public Health. 25 2018;15(2).
3. O’Donnell D, Ní Shé É, McCarthy M, Thornton S, Doran T, Smith F, et al. Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting. BMC Health Serv Res. 5 nov 2019;19(1):797.
4. Fry M, Gallagher R, Chenoweth L, Stein-Parbury J. Nurses’ experiences and expectations of family and carers of older patients in the emergency department. International Emergency Nursing. janv 2014;22(1):31‑6.
5. Rodakowski J, Rocco PB, Ortiz M, Folb B, Schulz R, Morton SC, et al. Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis. J Am Geriatr Soc. août 2017;65(8):1748‑55.
6. National Quality Forum. Emergency Department Transitions of Care - A Quality Measurement Framework Final Report (Internet). 2017 (cité 14 juill 2021).
7. Ontario Hospital Association. Leading Practices in Emergency Department Patient Experience (Internet). 2010 (cité 14 juill 2021).
8. Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):20‑30.
9. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179‑86.

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