Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study
Introduction: Older adults often have multiple comorbidities; therefore, they are at high risk for adverse events after discharge. The 4Ms framework—what matters, medications, mentation, mobility—has been used in acute and ambulatory care settings to identify risk factors for adverse events in older...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2024-01-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/4nd2734n |
| _version_ | 1797215593132195840 |
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| author | Mackenzie A. McKnight Melissa K. Sheber Daniel J. Liebzeit Aaron T. Seaman Erica K. Husser Harleah G. Buck Heather S. Reisinger Sangil Lee |
| author_facet | Mackenzie A. McKnight Melissa K. Sheber Daniel J. Liebzeit Aaron T. Seaman Erica K. Husser Harleah G. Buck Heather S. Reisinger Sangil Lee |
| author_sort | Mackenzie A. McKnight |
| collection | DOAJ |
| description | Introduction: Older adults often have multiple comorbidities; therefore, they are at high risk for adverse events after discharge. The 4Ms framework—what matters, medications, mentation, mobility—has been used in acute and ambulatory care settings to identify risk factors for adverse events in older adults, although it has not been used in the emergency department (ED). We aimed to determine whether 1) use of the 4Ms worksheet would help emergency clinicians understand older adult patients’ goals of care and 2) use of the worksheet was feasible in the ED. Methods: We conducted a qualitative, descriptive study among patients aged ≥60 years and emergency clinicians from January–June 2022. Patients were asked to fill out a 4Ms worksheet; following this, semi-structured interviews were conducted with patients and clinicians separately. We analysed data to create codes, which were divided into categories and sub-categories. Results: A total of 20 older patients and 19 emergency clinicians were interviewed. We identified two categories based on our aims: understanding patient goals of care (sub-categories: clinician/ patient concordance; understanding underlying goals of care; underlying goals of care discrepancy) and use of 4Ms Worksheet (sub-categories: worksheet to discussion discrepancy; challenges using worksheet; challenge completing worksheet before discharge). Rates of concordance between patient and clinician on main concern/goal of care and underlying goals of care were 82.4% and 15.4%, respectively. Conclusion: We found that most patients and emergency clinicians agreed on the main goal of care, although clinicians often failed to elicit patients’ underlying goal(s) of care. Additionally, many patients preferred to have the interviewer fill out the worksheet for them. There was often discrepancy between what was written and what was discussed with the interviewer. More research is needed to determine the best way to integrate the 4Ms framework within emergency care. |
| first_indexed | 2024-04-24T11:32:32Z |
| format | Article |
| id | doaj.art-e2b69f98ceca4de586c0e8430a52256d |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-04-24T11:32:32Z |
| publishDate | 2024-01-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-e2b69f98ceca4de586c0e8430a52256d2024-04-10T08:57:29ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-01-0125223023610.5811/westjem.1808818088Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative StudyMackenzie A. McKnight0Melissa K. Sheber1Daniel J. Liebzeit2Aaron T. Seaman3Erica K. Husser4Harleah G. Buck5Heather S. Reisinger6Sangil Lee7University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IowaUniversity of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IowaUniversity of Iowa, College of Nursing, Iowa City, IowaUniversity of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, IowaPenn State University, Ross and Carol Nese College of Nursing, University Park, PennsylvaniaUniversity of Iowa, College of Nursing, Iowa City, IowaUniversity of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, IowaUniversity of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, IowaIntroduction: Older adults often have multiple comorbidities; therefore, they are at high risk for adverse events after discharge. The 4Ms framework—what matters, medications, mentation, mobility—has been used in acute and ambulatory care settings to identify risk factors for adverse events in older adults, although it has not been used in the emergency department (ED). We aimed to determine whether 1) use of the 4Ms worksheet would help emergency clinicians understand older adult patients’ goals of care and 2) use of the worksheet was feasible in the ED. Methods: We conducted a qualitative, descriptive study among patients aged ≥60 years and emergency clinicians from January–June 2022. Patients were asked to fill out a 4Ms worksheet; following this, semi-structured interviews were conducted with patients and clinicians separately. We analysed data to create codes, which were divided into categories and sub-categories. Results: A total of 20 older patients and 19 emergency clinicians were interviewed. We identified two categories based on our aims: understanding patient goals of care (sub-categories: clinician/ patient concordance; understanding underlying goals of care; underlying goals of care discrepancy) and use of 4Ms Worksheet (sub-categories: worksheet to discussion discrepancy; challenges using worksheet; challenge completing worksheet before discharge). Rates of concordance between patient and clinician on main concern/goal of care and underlying goals of care were 82.4% and 15.4%, respectively. Conclusion: We found that most patients and emergency clinicians agreed on the main goal of care, although clinicians often failed to elicit patients’ underlying goal(s) of care. Additionally, many patients preferred to have the interviewer fill out the worksheet for them. There was often discrepancy between what was written and what was discussed with the interviewer. More research is needed to determine the best way to integrate the 4Ms framework within emergency care.https://escholarship.org/uc/item/4nd2734n |
| spellingShingle | Mackenzie A. McKnight Melissa K. Sheber Daniel J. Liebzeit Aaron T. Seaman Erica K. Husser Harleah G. Buck Heather S. Reisinger Sangil Lee Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study Western Journal of Emergency Medicine |
| title | Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study |
| title_full | Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study |
| title_fullStr | Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study |
| title_full_unstemmed | Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study |
| title_short | Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study |
| title_sort | usability of the 4ms worksheet in the emergency department for older patients a qualitative study |
| url | https://escholarship.org/uc/item/4nd2734n |
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