Assessment Tools

What assessment tools are used in the emergency department?

Seniors in the emergency department represent a unique clientele; it is important that they benefit from multidimensional assessments tailored to their specific situation in order to predict their future needs. In the absence of such assessments, the functional status of seniors has been found to decline, leading to repeated visits to the emergency department and to frequent admissions in hospital settings (Lee et al., 2001; McCusker et al., 2001; Rudman et al., 1998; Runciman et al., 1996).  

  • McCusker, J., Verdon, J., Tousignant, P., De Courval, L. P., Dendukuri, N. and Belzile, E. (2001). Rapid Emergency Department Intervention for Older People Reduces Risk of Functional Decline: Results of a Multicenter Randomized Trial. Journal of the American Geriatrics Society, 49(10), 1272–1281. http://dx.doi.org/10.1046/j.1532-5415.2001.49254.x
  • Rudman, D., Eimantas, T., Hall, M. & Maloney, K. (1998). Preliminary investigation of the content validity and clinical utility of the predischarge assessment tool. Canadian Journal of Occupational Therapy, 65(1), 3-11. http://dx.doi.org/10.1177/000841749806500101
  • Runciman, P., Currie, C. T., Nicol, M. and Green, L. (1996). Discharge of elderly people from an accident and emergency department: evaluation of health visitor follow-up. Journal of Advanced Nursing, 24(4), 711–718. http://dx.doi.org/10.1046/j.1365-2648.1996.02479.x

Multidimensional assessments performed in emergency departments lead to interventions that have positive impacts on daily activities, cognition, level of satisfaction with care and could reduce the number of repeat visits to the emergency department and institutionalization rates (Caplan et al., 2004; Mion et al., 2001). This situation testifies to the need for measurement tools that facilitate both referrals and the planning of health services on discharge for the emergency department (Aminzadeh & Dalziel, 2002; Adams & Gerson 2003).

  • Aminzadeh, F. and Dalziel, W.B. (2002). Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Annals of Emergency Medicine, 2002. 39(3), 238-247. http://dx.doi.org/10.1067/mem.2002.121523
  • Caplan, G. A., Williams, A. J., Daly, B. and Abraham, K. (2004). A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department—The DEED II Study. Journal of the American Geriatrics Society, 52(9), 1417–1423. http://dx.doi.org/10.1111/j.1532-5415.2004.52401.x
  • Mion, L. C., Palmer, R. M., Anetzberger, G. J. and Meldon, S. W. (2001). Establishing a Case-Finding and Referral System for At-Risk Older Individuals in the Emergency Department Setting: The SIGNET Model. Journal of the American Geriatrics Society, 49(10), 1379–1386. http://dx.doi.org/ 10.1046/j.1532-5415.2001.49270.x

Screening tools:

There are two main screening tools designed and validated for emergency department use: the ISAR tool (Identification of Seniors At Risk) and the PRISMA-7 tool (Program of Research to Integrate the Services for the Maintenance of Autonomy). Both tools are easy to use, useful and valid; their use can be adapted to available resources.

  • McCusker, J., Bellavance, F., Cardin, S., Trépanier, S., Verdon, J. and Ardman, O. (1999). Detection of older people at increased risk of adverse health outcomes after an emergency visit : The ISAR screening tool. Journal of the American Geriatrics Society, 47(10), 1229-1237. http://dx.doi.org/10.1111/j.1532-5415.1999.tb05204.x

The ISAR screening tool was designed to identify persons visiting emergency departments currently experiencing a loss of autonomy or at risk of losing autonomy within the next six months. For its part, the PRISMA-7 questionnaire identifies persons who are experiencing a loss of autonomy in several types of clinical settings, including emergency departments.

For more detailed information on the ISAR tool:

For more detailed information on the PRISMA-7 tool:

Assessment tools in the emergency department:

Screening tools make it possible to identify seniors at risk for functional decline, rehospitalisation or death (McCusker et al., 1999, 2001, 2007) but provide no information regarding their functional status, which is a concept that makes reference to individuals’ capacity to engage in their activities (to get around, to care of their personal needs, to prepare their meals, to maintain their home, to engage in their leisure activities, etc.) and fulfill their social roles (as a retiree or a member of a family or of a community, etc.), in the most satisfying manner possible. Functional Status Assessment goes beyond a person’s medical condition in the emergency department (Adams & Gerson, 2003) and requires the use of assessment tools that are adapted to this clinical context. Precise data on functional status are needed to plan resources and follow-ups for seniors upon discharge from the emergency department.

  • McCusker, J., Bellavance, F., Cardin, S., Trépanier, S., Verdon, J. and Ardman, O. (1999). Detection of older people at increased risk of adverse health outcomes after an emergency visit : The ISAR screening tool. Journal of the American Geriatrics Society, 47(10), 1229-1237. http://dx.doi.org/10.1111/j.1532-5415.1999.tb05204.x
  • McCusker, J., Verdon, J., Tousignant, P., De Courval, L. P., Dendukuri, N. and Belzile, E. (2001). Rapid Emergency Department Intervention for Older People Reduces Risk of Functional Decline: Results of a Multicenter Randomized Trial. Journal of the American Geriatrics Society, 49(10), 1272–1281. http://dx.doi.org/10.1046/j.1532-5415.2001.49254.x
  • McCusker, J., Verdon, J., Veillette, N., Berg, K., Emond, T. and Belzile, E. (2007). Standardized screening and assessment of older emergency department patients: a survey of implementation in Quebec. Canadian Journal of Aging, 26(1), 49-57. http://dx.doi.org/10.3138/G236-P856-815W-3863

A systematic review of all functional assessments used in emergency departments (on a global scale and with seniors) was published in 2013. This study identified functional assessment tools used in emergency departments, analyzed psychometric properties (validity, fidelity, clinical usefulness, applicability and sensitivity to changes) and issued recommendations for the practice. A total of 14 tools were identified and, upon analysis, four types of assessments [the Identification of Seniors At Risk (ISAR), the Triage Risk Screening Tool (TRST), the Older American Resources and Services (OARS) and the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED)] were recommended for practice in emergency departments. More specifically, the ISAR and TRST assessments are adapted to fast screenings, while the OARS and FSAS-ED assessments are recommended to acquire an overall understanding of functional performance.

  • Bissett, M., Cusick, A. & Lannin, N. A. (2013). Functional assessments utilised in emergency departments: a systematic review. Age and Ageing, 42(2), 163-172. http://dx.doi.org/10.1093/ageing/afs187

Bissett et al. (2013), Crennan and MacRae (2010), Cusick et al. (2009) and Veillette et al. (2007) identified the assessment tools used by occupational therapists in emergency departments. It follows from this literature review that occupational therapists most often use assessment tools that measure only one dimension of the functional status at a time (cognition, balance, etc.). They then combine various tools in order to assess multiple functional aspects in their clients.

  • Crennan, M. and Macrae, A. (2010). Occupational Therapy Discharge Assessment of Elderly Patients from Acute Care Hospitals. Physical & Occupational Therapy in Geriatrics, 28(1), 33-43. http://dx.doi.org/10.3109/02703180903381060
  • Veillette, N., Demers, L. & Dutil, E. (2007). Description de la pratique des ergothérapeutes du Québec en salle d'urgence. Revue Canadienne d’Ergothérapie, 74(4), 348-358. http://dx.doi.org/10.2182/cjot.07.006
  • Bellemare, J. (2013). Description de la pratique des ergothérapeutes dans les départements d’urgence au Québec (M.Sc., Université du Québec à Trois-Rivières). Retrieved from http://depot-e.uqtr.ca/6883/