Final Report of knowledge transfer activities submitted to CIHR

KT activities/strategies fulfilled under the CIHR project

The principal objective of this project was to translate research knowledge related to the functional status assessment of older adults into action in Emergency Departments (EDs).  Our project aimed to develop a systematic process for the functional assessment of older adults in the ED leading to improved patient and system outcomes, using a variety of evidence-informed knowledge translation strategies.

An interdisciplinary team of researchers, clinicians and decision makers interested in improving patient outcomes and flow through the use of occupational therapy (OT) services in the ED worked through the following activities:

1. Translation and adaptation of the original French version of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED) tool.

Considering the typical characteristics of older adults presenting to the ED (e.g. presentation for an acute condition, length of stay in ED, additional burden associated with data collection, etc.) it was not  possible to follow Vallerand’s criteria for translation and trans-cultural adaptation entirely [1]; indeed, it was not acceptable (ethically and administratively) to increase the length of stay in the ED by asking bilingual patients to perform a parallel translation/back-translation with the two versions of the FSAS-ED (English and French). Therefore, a professional translator translated both the form and user’s manual (Traductions Freynet-Gagné, from Winnipeg).

Then, only the form underwent the following steps:

1)   Parallel translation/ back-translation performed by bilingual OTs (Valerie Pion and Michelle Plante);

2)   Expert committee review leading to an experimental version (Marlene Stern, Leanne Leclair, Ashley Struthers, Martine Levesque and Jennifer A. Strachan)

3)   Pre-test to ensure wording clarity of the form with the participation of 20 older adults who were assessed in one of the WRHA EDs by an OT trained to use the tool (Leanne Leclair, Winnipeg Coordinator; Valerie Pion, OT; Karley Van Den Bussche, project staff).

4)   Revisions were completed as needed.

2. Development of educational material for the FSAS-ED tool.

The goal of this step was to develop material intended to support training sessions.

1)   The English version of the FSAS-ED user’s manual was revised (Marlene Stern, Leanne Leclair, Ashley Struthers, Valerie Pion, Karley Van Den Bussche and Jennifer A. Strachan).

2)   The FSAS-ED form and user manual were edited in a “user friendly” way (Melissa Colbeck).  

3)   Also, given that institutions have different levels of services for seniors in the ED and support for OTs working in the ED, these context-specific differences were considered to adapt the FSAS-ED forms accordingly (Marlene Stern, Leanne Leclair, Ashley Struthers, Valerie Pion, Marie-Claude Beaudoin and Myriam Lachance).

4)   Instructional case studies were developed to support training sessions. Situations addressed ED clients ED with either physical, cognitive or communication impairment, in order to provide examples of typical cases referred to OTs in the ED (Marie-Claude Beaudoin, Julia Robitaille). Cases studies were then translated in English (Michelle Plante, Martine Levesque and Leanne Leclair).

5)   Videos of simulated patients were produced to illustrate the administration of the FSAS-ED (both in French and English). The screenplays were developed based on two of the instructional case studies (Marie-Claude Beaudoin, Julia Robitaille, Eve Dulude and Leanne Leclair), then translated in English (Eve Dulude, David Quinn, Leanne Leclair and a professional translator called “Les mordus de la langue”, from Montréal). The French and English videos about Mrs Coté presented a typical situation of a lady in the ED because of physical issues following a fall (videos are approximately 14 minutes). Also, the French and English videos about Mr Thompson presented a typical situation of a man with cognitive or communication impairment (and his daughter who is the caregiver) in the ED because of his general deterioration of health (videos are approximately 12 minutes).
The four videos were filmed at the « Centre d'apprentissage des attitudes et habiletés cliniques (CAAHC) de l’Université de Montréal » with the assistance of Kathleen Sanzone, Team Leader & Trainer for clinical care simulation at CAAHC. The production was directed by a professional company (Les Réalisations Pier-Philippe Chevigny).

6)   The FSAS-ED user’s manual was revised based on the experience of an OT working full time in the ED (M. Lachance) who used the French version of the FSAS-ED to assess more than 700 older adults. Additional details were included in Chapter 5: Administration of the tool and a frequently asked question section was added to the user manual.

3. Development of a Website.

A website was developed where knowledge users, researchers, and other interested parties will find a reference list on research related to the assessment of functional status of older adults in the ED, all research and educational materials on the FSAS-ED as well as information related to implementation strategies.

4. National and International Conferences.

Paper (4) and poster (5) presentations took place in various Occupational Therapy, Emergency Medicine and Geriatric Conferences on the assessment of the functional status of older adults in the Emergency Department as well as on the FSAS-ED: 

1)   Veillette, N.; Sirois, M.J.; Stern, M.; Leclair, L.; Struthers, A. (2013). Knowledge Translation Strategies Promoting the Use of the FSAS-ED. Poster presentation at the Canadian Association of Occupational Therapists Annual Conference, Victoria, CB.

2)   Veillette, N.; Beaudoin, M.C.; Sirois, M.J.; Stern, M.; Leclair, L.; Struthers, A. (2013). The Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED): its clinical utility. Paper presentation at the Canadian Association of Occupational Therapists Annual Conference, Victoria, CB.

3)   Robitaille, J.; Veillette, N.; Freeman, A. (2013). Functional assessment of older people with cognitive disabilities in emergency. Poster presentation at the Canadian Association of Occupational Therapists Annual Conference, Victoria, CB.

4)   Veillette, N.; Beaudoin, M.C.; Sirois, M.J.; Stern, M.; Leclair, L.; Struthers, A. (2013). The Clinical Utility of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED). Poster presentation at the 2013 Conference of the Canadian Association of Emergency Physicians, Vancouver, BC.

5)   De Grandpré, N.; Sirois, M.J; Veillette, N. (2014).Demonstration of the clinical utility of the “Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED)” with independent seniors consulting Emergency Department (ED) for minor injuries. Poster presentation at the 43^rd Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Niagara Falls, ON.

6)   Veillette, N.; Beaudoin, M.C. (2014). The clinical utility of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED): a longitudinal case-control study. Poster presentation at the 43^rd Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Niagara Falls, ON.

7)   Veillette, N.; Beaudoin, M.C.; Robitaille, J. (2014). The clinical utility of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED). Paper presentation at the 16^th International Congress of the World Federation of Occupational Therapists, Yokohama, Japan.

8)   Veillette, N.; Beaudoin, M.C. (2015). Clinical utility of a functional status assessment in emergency department. Paper presentation at the Canadian Association of Occupational Therapists Annual 2015 Conference, Winnipeg, MB.

9)   Veillette, N.; Sirois, M.J; De Grandpré, N.; Giroux, M. (2015). Assessment of independent seniors consulting Emergency Department for minor injuries. Paper presentation at the Canadian Association of Occupational Therapists Annual 2015 Conference, Winnipeg, MB.

As well as invited presentations by Nathalie Veillette (6, including one keynote presentation): 

1)   Clinical utility of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED). Keynote presentation as part of the Symposium “Transition Across the Points of Care”, 41^st Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Vancouver, CB. (2012)

2)   The importance of assessing older adults functional status: The development of the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED). Research and Evaluation Unit, the Emergency Program of the Winnipeg Regional Health Authority Winnipeg (WRHA), the Occipational Therapy Department of the University of Manitoba and the George and Fay Yee Centre for Healthcare Innovation, MB (2012).

3)   L’évaluation du statut fonctionnel des personnes âgées en consultation à l'urgence. Colloque « Vieillir au XXIe siècle: approches préventives, diagnostiques et restauratives », Montréal, QC. (2012)

4)   Pourquoi évaluer le fonctionnement des personnes âgées à l'urgence?
Conférences « 5@7: Savoirs Partagés », Trois-Rivières, QC. (2013)

5)   L’évaluation du statut fonctionnel des personnes âgées en consultation à l'urgence. «Colloque national  sur la mobilité et le vieillissement; orientations futures en clinique et en recherche », Ottawa, ON. (2014)

6)   L’évaluation du statut fonctionnel des personnes âgées en consultation à l'urgence. «Centre de recherche de l’Hôpital St Mary’s », Montréal, QC. (2014)

7)   L’évaluation du statut fonctionnel des personnes âgées en consultation à l'urgence. «Midi scientifique du Centre d’Excellence en Vieillissement de Québec », Québec, QC. (2014)

5. Pre-conference workshop.

As part of the official program of the 2012 Annual Conference of the CAOT, OTs interested in developing their assessment skills for the ED participated in a one day training session. In addition to sharing professional experiences with individuals working in similar fields of practice, this continuing education activity provided OTs with the basic knowledge needed to use the FSAS-ED.

6. Symposiums (2).

1)   Symposium «Geriatric-friendly inter professional care in the emergency department: A functional status assessment process for older adults »

In June 2012, in Québec City, our team coordinated a national interprofessional symposium devoted to the assessment of functional status in the ED. This bilingual symposium (with simultaneous translation) brought together 120 professionals from various disciplines (physicians, nurses, social workers, physiotherapists, occupational therapists and managers).

Eleven speakers from Canada delivered 5 presentations:

     1.   Geriatric Friendly Care in the Emergency Department:

• Annik Dupras, Internist-Geriatrician  (Centre Hospitalier de l’Université de Montréal)
• Laura Wilding, Advanced Practice Nurse in Geriatric Emergency Management  (Ottawa Hospital)

     2.   Interprofessional Care in the Emergency Department

• Anita Petzold , Occupational Therapist and Patricia Barassi, Physiotherapist (McGill University Health Centre)
• Marlene Stern, Regional Director, Occupational Therapy (Winnipeg Regional Health Authority)
  and Valerie Pion, Occupational Therapist  (Health Sciences Centre, Winnipeg)

     3.   The Functional Status Assessment of Seniors in the Emergency Department

• Nathalie Veillette, Professor at the OT Department (Université du Québec à Trois-Rivières)
• Julia Robitaille, Occupational Therapist (Centre Hospitalier Universitaire de Quebec)
• Marie-Claude Beaudoin, Administrative Director of Rehabililtation Program (Centre de Santé et des Services Sociaux Pierre-De-Saurel)

     4.   Canadian Emergency Team Initiative

• Marie-Josée Sirois, Professor at the Rehabilitation School  (Laval University)

     5.   National Direction of Emergency

• Dr Daniel Lefrançois, directeur à la Direction nationale des urgences, des services de traumatologie et des services préhospitaliers d’urgence

2)   National meeting of occupational therapists working or conducting research in the Emergency Department 

In May 2013, in Victoria, BC, occupational therapists working or conducting research in the Emergency Department had the opportunity to meet with therapists from across the country and work together to improve occupational therapy services and health care delivery for older adults presenting to the ED. The agenda for the session included:

     1. Introductions

     2. Sharing of best practices with older adults in the ED: Our journey to improve outcomes through interprofessional client-centred collaborative practice in the Winnipeg Emergency Departments

• Marlene Stern, Regional Director, Winnipeg Regional Health Authority
• Valerie Pion, Occupational Therapist, Health Sciences Centre

     3. Ideas for networking and moving forward

     4. Next steps

7. Application of knowledge/Implementation activities.

Our team developed partnerships with key hospital stakeholders that indicated interest in implementing the FSAS-ED in their ED, to collaboratively implement a systematic process (that includes the FSAS-ED) for the functional status assessment of older adults within each of their EDs. In addition to partnerships, various other KT strategies were utilized including training OTs, and ongoing support. 

As part of implementation activities, several workshops were offered to OTs interested in developing their assessment skills in the ED.

One day training sessions were held in:

2011 (one session) :     5^th of December 2011, in Québec City, QC

2012 (two sessions) :   2^nd of March 2012, in Winnipeg, MB
                                        6^th of June 2012, in Québec City, QC

2013  (one session) :    1^rst of October 2013, in Sorel, QC

2014 (four sessions) : 24^th of April and 2^nd of June 2014, in Québec City, QC
                                       18^th of July 2014, in Trois-Rivières, QC
                                       21^rst of October 2014, in Sorel, QC
                                       3^rd and 4^th of December 2011, in Québec City, QC

2015 (one session) :    11^th of March, in Ormstown, QC