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Managing the Geriatric Boom

Joe Cantlupe, for HealthLeaders Media, November 14, 2011
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Kadlich also says that hospital officials were concerned about the ability to evaluate a geriatric patient’s condition in the regular ED. “We simply don’t have the time to figure out an underlying condition,” she says. “Once we set in motion the special ED unit for geriatric patients, we brought in a practice nurse who specialized in geriatrics and the remaining ED staff received a certification course in geriatrics. Over time, we figure to see a reduction in readmissions in that population.”

Before the hospital launched the new ED, hospital leadership met with regular ED physicians and “got their buy-in from day one,” she says. “They were very supportive and receptive. One of the first things they did was portion out our rooms in the ED to have five senior rooms among the 26 ED rooms, with geriatric nurses assigned to them.”

While the hospital is still evaluating data on the program, the new geriatric ED appears to have resulted in more hospital admissions, Kadlich says. Preliminary figures show that at least 11% of patients who have visited the geriatric ED have been admitted to the hospital, with many admissions the result of patients having chronic conditions.

“The return on investment is when you see a decrease of readmission due to aligning the patient population. If the program is successful, your patient is really at the front door of the hospital,” she adds. “The elderly are very vocal about what they want, how they want it, and if they have a great experience they tell their card parties, their church buddies, just general word of mouth.”

Brad Bertke, president and CEO, says the hospital was impressed by the program. “This was very consistent with where we’ re going with geriatric care, and it primarily involved training. We didn’t spend much money on facility renovations; the bulk of it was spent on training on staff and that was the key.”

Success key No. 3: Bridge to home

One of the major concerns for hospital systems is when patients, particularly the elderly, leave the hospital to go home; they can be at risk for rehospitalizations, which are costly for patients as well as the hospital system. The Summa Health Systems Bridge to Home program provides what hospital officials describe as a safety net for discharged patients.

The seven-hospital, 2,092-bed system based in Akron, OH, initiated its Bridge program as a hybrid of various protocols, and it includes a partnership with Summa’s own health plan, SummaCare, to offset costs.

Essentially, it consists of an ACE model, with three geriatric nurse specialists, a geriatrician, and a social worker who coordinate care for diet, medication, and pain management protocols. “It is a care-driven protocol, shown to help the daily living function of the elderly patient,” says Steven M. Radwany, MD, FACP, FAAHPM, Summa’s medical director of palliative care and hospice services, and interim medical director for postacute and senior services.

The hospital is able to identify potentially high-risk medications earlier and establish early discharge planning. As a result, “we have more discharges with greater satisfaction and closer follow-up for the patient,” he says

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