Do You Have a Plan for Your ED?

Carrie Vaughan, for HealthLeaders Media, January 30, 2009

I've heard of acute-care inpatient units tailored for elderly patients with hand rails and nonslip flooring. Some even have in-room refrigerators to help patients stay hydrated and additional furniture for a more home-like feel. But an emergency room designed specifically for elderly patients? That's a new one.

But that's exactly what Holy Cross Hospital in Silver Spring, MD, has created. According to this Washington Post article, the idea was sparked after Holy Cross CEO Kevin Sexton received a call from his mother who was "stressed out" in an ER in New Jersey due in part to the crowded and chaotic environment.

So what exactly does Holy Cross' eight-room senior emergency center boast? Elderly patients who have non life-threatening ailments are taken to their own cubicle that has a comfortable chair for family members and loved ones. It also features plenty of blankets, pillows, and a thicker mattress than traditional ER beds, which can help prevent bedsores. The center, which cost $150,000, also features wooden handrails, nonslip faux wood floors, a large-face clock, and a television with headset. In addition, staff members are trained to communicate with elderly patients whose hearing may be impaired or who may need additional time to process information.

It's clear that aging baby boomers will place a huge burden on healthcare facilities in the years ahead. Already the main driver behind the increase in ED visits—which have grown by 36% since 1996 to about 119 million in 2006—is the aging population, according to an August 2008 report by the Centers for Disease Control and Prevention. So finding ways to provide safer and more effective care to these patients is a top concern for healthcare executives. The trick, of course, is doing that in a way that's affordable.

I'm glad healthcare leaders are improving services for elderly patients, because I'd love for my own grandparents and loved ones to have access to a senior emergency room to make what's usually an unpleasant experience more tolerable. But I can't help but wonder about the plan (and the viability of that plan) to improve care and the overall experience for the rest of us crammed together in the general ED.

I was pleased to learn recently that there are some low-cost solutions that can make the wait more bearable, speed up the admission process, and improve quality. For example, Scripps Health in San Diego is using restaurant-style beepers in its ED for patients who don't need to be restricted to a bed. This enables them to move about, but if a test result is back or the physician is ready to treat them, they can be easily paged. The pagers also help staff members avoid wasting precious minutes trying to track down a wandering patient.

If a pager can keep hungry people from badgering a hostess about when their table will be ready, perhaps it can also help keep patients calm and free up staff time to focus on getting patients moved through the ED more quickly.

Editor's note: If you would like to learn more about low-cost strategies to reduce crowding, admission wait times, and improve customer satisfaction, please join us on Feb. 20, 2009 for a live Webcast, ED Overhaul 2009: Five improvements to make today, which features executives from Scripps Health, Cedars-Sinai Medical Center, and William Beaumont Hospital.

Carrie Vaughan is leadership editor with HealthLeaders magazine. She can be reached at
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