Contents lists available at ScienceDirect International Emergency Nursing journal homepage: www.elsevier.com/locate/aaen Case study The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method Andrea Taylor a,b,c, ⁎ , Marc Broadbent a , Apil Gurung a , Marianne Wallis a a University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs Queensland 4556, Australia b Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya Queensland 4575, Australia c Healthcare Improvement Unit, Clinical Excellence Queensland, Level 2, 15 Butterfield Street, Herston, Queensland 4006, Australia ARTICLE INFO Keywords: Emergency service, hospital Aged Geriatric assessment Consensus process ABSTRACT Background: The universal screening and comprehensive assessment of older persons presenting to the emer- gency 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. Method: The modified comprehensive geriatric assessment was formulated using the RAND/UCLA appro- priateness methodology incorporating consensus opinion from an expert group of clinicians and the best sci- entific 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. Results: 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. Conclusion: 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. 1. Introduction A growing proportion of adults presenting to emergency depart- ments (EDs) globally, are older and frail [1,2]. The potential adapta- tions to service delivery required to meet this escalating demand can be difficult to achieve as they involve changes to the environment, staffing and operational rules [3,4]. Comprehensive geriatric assessment (CGA) has long been considered the gold standard for examining comorbid- ities and identifying problems associated with the older adult, including the domains of cognition, mood, polypharmacy, risk of falls, functional status, instrumental activities of daily living, nutritional status and so- cial support [5,6]. When linked to interventions, the use of CGA in the ED has been considered useful to guide decision-making, and to identify unmet issues including those not exposed by routine medical assess- ment alone [6–8]. However, the time required to undertake a full CGA in the fast paced ED environment can be problematic [2,7,9]. In Australia, the introduction of the National Emergency Access Target stipulated that a proportion of patients should be admitted, discharged or transferred from EDs within four hours of presentation [10]. For frail older adults with multiple comorbidities, it is easy for a rapid ED assessment to miss important diagnostic features that affect post ED functioning and safety. There have been attempts to develop a multidimensional geriatric assessment instrument or process specific for use in the ED setting some with outcome evaluation [11]. Inter- nationally and within Australia, studies have explored models of care which incorporated the use of components of CGA to improve patient and health service outcomes, including decreasing ED and inpatient length of stay [12–14]. However, the composition of a CGA for use, in the ED, using research evidence and consensus methodology, is yet to be undertaken. Incorporating CGA in the ED requires consideration of key aspects to ensure cultural uptake and sustainability. These aspects include https://doi.org/10.1016/j.ienj.2020.100847 Received 13 November 2019; Received in revised form 4 February 2020; Accepted 10 February 2020 ⁎ Corresponding author at: Healthcare Improvement Unit, Clinical Excellence Queensland, Level 2, 15 Butterfield Street, Herston, Queensland 4006 Australia. E-mail addresses: andrea.taylor2@health.qld.gov.au (A. Taylor), mbroadbent@usc.edu.au (M. Broadbent), agurung@usc.edu.au (A. Gurung), mwallis@usc.edu.au (M. Wallis). International Emergency Nursing xxx (xxxx) xxxx 1755-599X/ © 2020 Elsevier Ltd. All rights reserved. Please cite this article as: Andrea Taylor, et al., International Emergency Nursing, https://doi.org/10.1016/j.ienj.2020.100847