Decreased readmission rates and increased patient satisfaction are crucial factors behind the rise of geriatric emergency rooms in hospitals around the country, say officials at facilities that provide the specialized ERs.
An aging population translates to more patients age 65 and older entering ERs nationwide. In 2009 and 2010, a total of nearly 20 million patients 65 and older presented at ERs throughout the United States, according to the National Hospital Ambulatory Medical Care Survey. That is equivalent to the population of Florida.
Meanwhile, the number of Americans who will celebrate a 65th birthday in the next 20 years rose by 33 percent from 2000 to 2011, notes a report by the Administration on Aging, which indicates the influx of senior patients making ER visits is likely to continue.
In response to this shift, more than 200 U.S. hospitals either have or are developing geriatric ERs, according to Pennsylvania-based research group ECRI Institute.
“What we were looking to do was to respond proactively to this significant need we were seeing and the change of the patient population’s age,” explains Ann Hess, MD, an emergency department physician of Saint Joseph Mercy Health System, which operates seven geriatric ERs in southeast Michigan.
“It’s a natural subspecialty for emergency medicine,” says Howard Dickey-White, MD, who is board- certified in emergency medicine, an American College of Emergency Room Physicians Fellow and Chief of Emergency Medicine Operations for University Hospitals in Ohio. “Seniors often don’t have an acute emergency; they have all of these comorbid problems, so we actually get to spend some time with them.”
Taking more time with patients is part of a multidisciplinary approach that hospitals implementing geriatric ERs employ to complete comprehensive assessments that encompass both physical and social aspects of care. In many geriatric ERs, pharmacists are available for medication consultation or a review of the Beers Criteria list, a set of guidelines by the American Geriatric Society identifying medications that may be inappropriate for older adults. Additionally, social workers are on staff to assess and address patients’ needs beyond their immediate medical situations and link them to community resources.
“The social worker in the emergency department in my opinion is a critical element,” says Eric Csernyik, DO, Emergency Medicine Physician Program Director at University Hospitals. “There’s a whole litany of things, and it is very time-consuming to go through all of these social needs in addition to taking care of whatever their medical needs may be that day.”
One component of the Good Samaritan Medical Center Senior ER in Lafayette, Colorado, is the availability of hospital volunteers as companions for patients who are alone.
“We have the opportunity to provide them with a caring companion, somebody who can come over and help them pass the time of day if they don’t have a family member with them,” says Judy Gorham, RN, MS, Director of Emergency and Trauma Services, Behavioral Health, and Nursing Resources at Good Samaritan, one of three SCL Health senior ERs in greater Denver.
Continuing education and geriatric training are key to helping clinicians perform more thorough screenings for conditions such as depression, dementia and delirium for this patient population. For example, all of the geriatric ERs within University Hospitals and Saint Joseph Mercy Health System have staff who are Geriatric Emergency Nurse Education-certified.
“We’ve also developed training modules that are available for physicians …, and we have different topics that specifically relate to working with geriatric emergency medicine,” Dr. Hess says.
Challenges and Benefits
Implementation of geriatric ERs does bring challenges in the form of funding, space allotment, environmental improvements and staff training. However, positive patient outcomes and decreased readmission rates justify the effort, hospital officials say.
“What our goal was when we did this was to decrease the readmission rates, making sure [patients] had the pharmacy review and discharge planning,” Gorham says. “We have seen a decrease as high as 10 percent in the patients who are readmitted in 48 hours.”
Despite an increase in the volume of patients 65 and older, Saint Joseph Mercy Health System has maintained 72-hour readmission rates of less than 1 percent since launching its geriatric ERs in 2010, notes Dr. Hess.
“One of our goals is to … maintain [patients] in their own living environment, which is usually what is healthiest for them overall and gives them the highest quality of life,” she says. “Our data is not yet conclusive, but our trends suggest that we’re seeing or pointing toward a decreased admission rate.”