The elder-friendly emergency department assessment tool: development of a quality assessment tool for emergency department-based geriatric care.

OBJECTIVES To develop and conduct a preliminary validation of selected subscales of an elder-friendly emergency department (ED) assessment tool. DESIGN Content validation of tool by an international panel. Construct validation using care ratings of ED lead physicians and nurses. SETTING Quebec, Canada. PARTICIPANTS The international panel comprised 34 clinicians, administrators, and researchers. The construct validation was based on a 2006 survey of ED lead physicians and nurses at all 103 EDs in the province, of whom 68 (66%) supplied complete data. MEASUREMENTS The initial tool included five subscales: ED staffing, screening and assessment, discharge planning, community services, and care philosophy. Differences in subscale scores were examined according to ED size, and of these scores were correlated with care ratings made by lead physicians and nurses. RESULTS The average scores for three subscales (ED staffing, discharge planning, and community services) varied according to ED size. After adjustment for ED size, three subscales (screening and assessment, discharge planning, and community services) were correlated with ED nurse or physician care ratings. A preliminary tool, taking into account all factors, is proposed. CONCLUSION This study provides preliminary evidence of the validity of three subscales of the proposed elder-friendly ED assessment tool. Results suggest that ED size should be considered in interpreting these subscales. Further evaluation and validation of the proposed tool will be needed to further its utility in helping to focus the quality improvement efforts of clinicians, managers, and administrators related to the care they provide older adults.