Assessing what matters most in older emergency department patients

Abstract

Background Older emergency patients have complex health needs and diverse personal priorities not captured by traditional single-disease approaches. Asking 'what matters most' may facilitate a more patient-centred approach. However, conceptual frameworks to document patient values have neither been implemented nor operationalised for use in the emergency department (ED). Objective To investigate the feasibility of asking 'what matters most' in the ED, assess patient priorities and determine the utility of a conceptual framework for documenting these. Methods Prospective, observational study in a Swiss ED with consecutive patients aged ≥65 years. Feasibility was determined as proportion of included patients to eligible patients. Patient responses were categorised using a conceptual framework consisting of 8 domains: principles, relationships, emotions, activities, abilities, possessions, medical and others. Framework evaluation included interrater reliability (IRR), time-to-abstraction rate and a questionnaire assessing utility of the framework. Results Asking what 'matters most' was feasible, including 1349 of 1625 patients (83.0%). Regarding categories of the conceptual framework, 504 patients (37.4%) reported medical issues, 297 (22.0%) relationships, 268 (19.9%) abilities and 154 (11.4%) emotions as their priority. Patients aged ≥85 years or having frailty more frequently prioritised abilities and emotions, whereas patients 65-84 years or without frailty prioritised medical issues. The framework showed substantial IRR (κ = 0.668), good time-to-abstraction rates and high ratings in the utility questionnaire. Conclusions Asking older people 'what matters most' is feasible and potentially useful in the ED setting. Applying a conceptual framework enables systematic documentation and may support patient-centred and holistic emergency care.