A trip to the emergency department can be overwhelming for any patient, but especially elderly patients. According to Pauline Chen in a New York Times Blog post, “ … when it comes to elderly patients, it is nearly impossible to work quickly. Many are plagued by multiple chronic diseases like diabetes, high blood pressure and heart disease, take numerous prescription drugs that can cross-react in potentially dangerous ways and suffer from ills like dementia that can make the answer to even the simplest of questions – What brought you to the emergency room today? – difficult to understand.”
As a result, hospitals around the United States have begun to open geriatric emergency centers designed to specifically address the needs of their oldest patients. These new EDs are staffed with personnel trained in geriatrics and include features like softer lighting, larger clocks, non-slip floors, and bedside toilets. Staff also are trained “to assess fall risk, dementia, malnutrition and other disorders common in elderly patients, including abuse and neglect,” according to David Ferguson in a recent Fiercehealth article.
In 2012, The Icahn School of Medicine at Mount Sinai received an award from the US Department of Health and Human Services to implement a new model of geriatric emergency care in three large, urban hospitals: The Mount Sinai Medical Center in New York City, St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL. The Geriatric Emergency Department Innovations through Workforce, Informatics and Structural Enhancements (GEDI-WISE) project received a $12.7 million grant for the project. At the beginning of 2014, the ECRI Institute, a nonprofit research organization dedicated to discovering the best in medical procedures, devices, drugs, and processes, estimates that there were 50 geriatric EDs in operation in the United States with another 150 in development.
As the issue of geriatric emergency care was emerging in late 2013 and early 2014, a set of Geriatric Emergency Department Guidelines was approved by the American College of Emergency Physicians, The American Geriatrics Society, Emergency Nurses Association, and the Society for Academic Emergency Medicine.
According to the introduction for those guidelines, EDs are in a unique position to care for the elderly population in the US. “As an ever-increasing access point for medical care, the ED sits at a crossroads between inpatient and outpatient care. Specifically, the ED represents 57% of hospital admissions in the United States, of which almost 70% receive a non-surgical diagnosis. The expertise which an ED staff can bring to an encounter with a geriatric patient can meaningfully impact not only a patient’s condition, but can also impact the decision to utilize relatively expensive inpatient modalities, or less expensive outpatient treatments.”
Those guidelines are intended to standardize and improve the care of geriatric patients, creating “a template for staffing, equipment, education, policies and procedures, follow-up care, and performance improvement measures.”
Most recently, geriatric emergency centers have been opened at Ohio State University’s Wexner Medical Center and Baltimore’s St. Agnes Hospital.
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