A simple quality-of-care intervention targeting nurses for improving care of older patients in the emergency department: a Western European multicenter study.

PURPOSE: Emergency departments (EDs) face significant challenges in delivering high-quality care for older patients. Identifying barriers and developing stakeholder-informed interventions are essential to improve ED care. This study aimed to identify nurses' perceived barriers to caring for older ED patients and to develop and evaluate a targeted intervention to improve care quality. METHODS: This multicenter quality improvement project (QIP) was conducted across EDs in four western European countries (2024-2025) using three iterative Plan-Do-Study-Act (PDSA) cycles. Cycle 1 involved a needs assessment among nurses to identify barriers. Cycle 2 focused on developing and evaluating the perceived helpfulness and feasibility of three proposed interventions. Cycle 3 implemented and evaluated the selected intervention. Nurses provided feedback throughout all PDSA cycles. RESULTS: In Cycle 1, 82 nurses from eight EDs in Belgium (n = 22), Germany (n = 20), Switzerland (n = 30), and Iceland (n = 10) identified time constraints (n = 92; 39%), behavioral disorders (n = 30; 13%), and communication difficulties (n = 25; 11%) as key barriers. In Cycle 2, three interventions were proposed: (1) a QR-code leaflet to facilitate geriatric anamnesis through relatives, (2) educational sessions for nurses, and (3) an informative poster promoting family involvement. The QR-code and poster were evaluated as most helpful and feasible. In Cycle 3, a combined poster-QR-code intervention was developed and implemented across all sites and was well received, though with no measurable effect at this stage. CONCLUSION: Iterative PDSA cycles provided a structured framework to identify barriers, co-develop, and refine a context-specific intervention for geriatric ED care. The absence of an immediate effect underscores that continuous iteration and stakeholder engagement are essential to further enhance geriatric care within the complex ED setting.