Designing a Best Possible Caregiver History to Facilitate Disposition Planning for Older Adults in Emergency Departments

Detailed information about caregivers is crucial for planning disposition from emergency departments (EDs), but it is unclear what specific information is useful for ED clinicians and how that information should be presented.

We used a Design Thinking approach to develop a standardized format-which we call a "Best Possible Caregiver History" (BPCH)-for displaying useful caregiver information to ED clinicians. The key steps of this approach are needfinding, followed by iterative cycles of ideation, rapid prototyping, and testing. For needfinding, we used semi-structured interviews of four ED clinicians on current practices for discovering and documenting caregiver information. For ideation and prototyping, we used rapid qualitative analysis to identify themes and used them as design constraints informing low-fidelity prototyping of the BPCH. For testing, we sought user feedback in interprofessional focus groups of ED social workers, nurses, therapists, and physicians. Focus group feedback was then analyzed to inform the design of subsequent prototypes, which were iteratively presented to subsequent focus groups five times.

Initial needfinding interviews found that caregiver information is gathered but often dispersed throughout the medical record, collected redundantly, and difficult to find and interpret. A structured and accessible shared note such as a BPCH would be useful. In focus groups, several design constraints for the BPCH emerged: caregiving data must include details about transportation, power of attorney, and home environment to be relevant for disposition, comprehensive, paired with functional assessments, and systematically presented. The BPCH does not require detail about persons or services helping with instrumental activities like shopping or banking. After five iterations, ED clinicians described the BPCH as useful.

We illustrate how Design Thinking can help rapidly develop a novel format for displaying details about caregivers that could facilitate safer disposition from the ED. The BPCH embodies what ED clinicians at our institution consider clinically relevant for their practice. Further research is needed to determine the feasibility, acceptability, and generalizability of this intervention.