Identification of seniors at risk: process evaluation of a screening and referral program for patients aged ≥75 in a community hospital emergency department

Reports on the authors' experience with a patient safety quality improvement program, intended to reduce the incidence and severity of adverse outcomes for emergency department (ED) patients aged ≥75. The Identification of Seniors at Risk scale was used for screening, and those at high risk were referred for appropriate intervention. The plan‐do‐study‐act improvement cycle was followed, conducting process evaluation to diagnose and correct implementation difficulties. Reports that: implementing an ED screening and referral program is deceptively difficult; process evaluation multidisciplinary working group meetings are an essential improvement tool; screening inclusion criteria had to be adapted to the subject population in order to make efficient use of staff time; the screening questions and process required ongoing assessment, revision, and local adaptation in order to be useful; and high‐risk screening in the ED is critical to a hospital system's ability to anticipate clinical problems; the plan‐do‐study‐act improvement cycle is a practical and useful tool for improving quality and systems in a real care setting.