Manish N. Shah

Most visits to the emergency department (ED) by persons living with dementia (PLWD) who are then discharged back into the community are preventable. However, care partners and other caregivers of the over 6 million PLWD residing in the United States lack the supports, services and timely access to clinical care to address many common needs in the community. Thus, care partners resort to taking the PLWD to the ED, a sub‐optimal environment that can be traumatic to the PLWD, increase iatrogenesis, and ultimately may not resolve the underlying reason for the visit. Longitudinal nurse‐led telephonic care (NLTC) provided following an ED visit with community discharge may present an effective and efficient model for health systems to support care partners, decant busy EDs, and provide high‐quality, person and family‐centered impactful care to support PLWD and their care partners. This paper describes the development of an NLTC program being implemented as part of the Emergency Departments LEading Transformation of Alzheimer's and Dementia Care (ED‐LEAD) trial, a factorially designed embedded pragmatic clinical trial in 79 EDs. The NLTC program utilizes components of two previously tested programs, the Aliviado Dementia Care quality improvement program, and the Emergency Medicine Palliative Care Access (EMPallA) nurse‐led telephonic palliative and transitional care program to support PLWD and their care partners. Successful implementation of the NLTC program may lead to increased uptake of NLTC programs by health systems, improving quality of care and quality of life for PLWD and their care partners.

INTRODUCTIONAmbulance collisions pose a significant risk to the public and are the leading cause of occupational fatalities among paramedics in the United States (U.S.)(1, 2). When lights and siren...

More than 6 million persons living with dementia (PLWD) in the United States rely on the emergency department (ED) for unscheduled care, with up to half discharged home after treatment. The ED‐to‐home transition poses significant challenges for PLWD and their care partners (referred to as “dyads”), contributing to high rates of ED revisits and adverse outcomes. The Community Paramedic‐led Transitions Intervention (CPTI) was developed to address these challenges by adapting the validated Care Transitions Intervention for the ED setting. Delivered by trained community paramedics, CPTI is a short‐term 30‐day program that includes one home visit and up to three follow‐up phone calls. Using a coaching model, paramedic coaches work with members of the dyad to strengthen their knowledge, skills, and confidence to manage their health and successfully navigate the health care system. CPTI is being implemented as part of Emergency Departments LEading the Transformation of Alzheimer's and Dementia Care (ED‐LEAD), a cluster‐randomized pragmatic trial testing 3 interventions designed to improve outcomes for PLWD discharged home from the ED across 14 health systems and 79 EDs nationwide. This paper describes the CPTI model as implemented within ED‐LEAD, detailing its theoretical foundation, structure, training curriculum, workflow integration, and implementation monitoring. This framework can provide a model for health systems, provider groups, and emergency medical service agencies interested in adopting this innovative approach and implementing the CPTI. Insights from its implementation within ED‐LEAD will guide future efforts to improve post‐ED outcomes and continuity of care for PLWD and their care partners.

Over 50% of persons living with dementia (PLWD) and their care partners (dyads) visit the emergency department (ED) every year. In the ED, healthcare professionals face complex challenges managing acute issues and symptoms of Alzheimer's disease and Alzheimer's disease–related dementias without provider training or in‐ED structures to ensure a successful discharge. While many of these visits are for conditions more suitable for ambulatory care, as many as 50% of PLWD discharged from the ED return within 30 days, suggesting opportunities to improve ED care, and discharge processes. Emergency Care Redesign (ECR) includes intentional workflows where physicians, nurses, and social workers engage in a team‐based approach with structured assessments to manage a myriad of potential psychosocial and behavioral issues contributing to the need for ED care. Three core components comprise this evidence‐based, efficient pragmatic intervention for PLWD and their care partners: (1) problem identification, (2) problem prioritization, and (3) provision of non‐pharmacologic solutions supported by community resources. Although these components are essential to provide optimal ED care and reduce revisits and other adverse outcomes, they require an embedded clinical decision support structure, focused training, and clear workflows. In this paper, we describe the ECR intervention as one of three being implemented in the cluster‐randomized multifactorial pragmatic trial, Emergency Departments LEading Transformation of Alzheimer's and Dementia Care (ED‐LEAD), designed to improve care for PLWD and their outcomes after discharge home within 15 health systems and 79 EDs across the United States.

Introduction: Of the 6 million people living with dementia (PLWD) in the United States, half visit an emergency department (ED) annually. Little is known about the specific emergency care preferences and priorities of PLWD and their care partners. This descriptive qualitative study engaged PLWD and care partners to identify their ED care priorities and the factors that influence their overall evaluation of ED care. Methods: We recruited PLWD receiving care in a large academic ED and their care partners to participate in individual or dyadic interviews. Interviews were analyzed using thematic analysis and member checking interviews were completed to confirm and expand on study findings. Results: We conducted interviews with 55 participants ( N = 19 PLWD, 24 care partners, 6 dyads). PLWD and care partners evaluated ED care experiences through a summative lens shaped by: (1) universal priorities common across all participants and (2) individual values that varied in importance and quality between individuals. Universal priorities included feeling respected, clear communication, and being informed about and involved in their emergency care decisions. Individual values included preferences around the who and how of decision‐making, attention to cognitive health, and degree of escalation of care. Several contextual factors shaped the appraisal of ED visits including the timing of evaluation and nature of the precipitating event (acute/unknown cause vs. chronic/known or suspected cause). Conclusion: Findings suggest that interpersonal interactions, including being informed about care and involved in decisions, strongly influence the evaluation of ED visits for PLWD. These findings can support the development of person‐centered outcome measures capable of evaluating these priorities.

Objective: During the COVID-19 pandemic, the United States Centers for Disease Control and Prevention provided strategies, such as extended use and reuse, to preserve N95 filtering facepiece respirators (FFR). We aimed to assess the prevalence of N95 FFR contamination with SARS-CoV-2 among healthcare personnel (HCP) in the Emergency Department (ED). Design: Real-world, prospective, multicenter cohort study. N95 FFR contamination (primary outcome) was measured by real-time quantitative polymerase chain reaction. Multiple logistic regression was used to assess factors associated with contamination. Setting: Six academic medical centers. Participants: ED HCP who practiced N95 FFR reuse and extended use during the COVID-19 pandemic between April 2021 and July 2022. Primary exposure: Total number of COVID-19-positive patients treated. Results: Two-hundred forty-five N95 FFRs were tested. Forty-four N95 FFRs (18.0%, 95% CI 13.4, 23.3) were contaminated with SARS-CoV-2 RNA. The number of patients seen with COVID-19 was associated with N95 FFR contamination (adjusted odds ratio, 2.3 [95% CI 1.5, 3.6]). Wearing either surgical masks or face shields over FFRs was not associated with FFR contamination, and FFR contamination prevalence was high when using these adjuncts [face shields: 25% (16/64), surgical masks: 22% (23/107)]. Conclusions: Exposure to patients with known COVID-19 was independently associated with N95 FFR contamination. Face shields and overlying surgical masks were not associated with N95 FFR contamination. N95 FFR reuse and extended use should be avoided due to the increased risk of contact exposure from contaminated FFRs.

A core tenant of the Geriatric Emergency care Applied Research Network 2.0—Advancing Dementia Care (GEAR 2.0‐ADC) is the inclusion of community members during all stages of clinical research. As such, we deliberately integrated and supported patient and public involvement in the evaluation and selection of GEAR 2.0‐ADC Pilot Research Grants by developing and adapting traditional grant application review structures, with input from community members, to create the GEAR 2.0‐ADC Community Review Committee approach. Community members, including persons living with dementia, effectively participated in all three rounds of research grant application review and selection, complementing the traditional scientific review process. The structure and flexibility of the GEAR 2.0‐ADC Community Review Committee approach serve as a model for patient and public grant application review involvement with strong potential for applications across grant reviews in other medical specialties.