5 Essentials of a Geriatric Emergency Department

Michelle Ponte, May 17, 2016

It is not enough for an organization to say it is geriatric-friendly. Geriatric EDs need to monitor hospital admission rates, readmission rates, patient transfers, patient outcomes, and patient experience to help prevent avoidable hospitalizations.

This article first appeared in the May 2016 issue of HealthLeaders magazine.

Hospital emergency departments have been challenged by a variety of factors, including the impact of healthcare reform, increasing numbers of people living with multiple chronic conditions, and a rapidly growing aging population.

One solution is the geriatric ED, which offers emergency care tailored to the specific needs of older adults, along with an opportunity to improve healthcare outcomes and reduce unnecessary hospitalizations and readmissions. In 2007, there were approximately 45 GEDs in the United States. "Today we believe there are over 100, and momentum is underway. It is very promising," says Terry Fulmer, PhD, RN, FAAN, president of the John A. Hartford Foundation in New York City, which supports initiatives to improve healthcare for older adults and seeks to grow the field of geriatric emergency medicine. Roughly 40 million Americans are 65, says Fulmer. What's more, she adds, is that people 85 and older are now the fastest growing population. As the population of older adults grows, emergency medicine experts believe GEDs could double in number.

GEDs are evolving and vary widely, from those with dedicated beds in a traditional ED to those with separate units that treat only older patients. Because GEDs are a relatively new care model, healthcare organizations may face various challenges when it comes to design, operations, staffing, and training. Successful GEDs implement clinical protocols and GED guidelines supported by multiple clinical associations that are aimed at helping providers quickly and efficiently assess, triage, and treat older patients. With the emergency room sitting at the intersection of outpatient and inpatient care, GEDs have the potential to significantly improve care for older patients.

"There's an opportunity now for the ED to be a partner in terms of care coordination and safely preventing avoidable hospitalizations," says Ula Hwang, MD, MPH, FACEP, an emergency physician, researcher, and an associate professor at the Icahn School of Medicine at Mount Sinai, who helps guide clinical GED operations at the 1,171-bed Mount Sinai Hospital in New York City. Not only that, but as GEDs evolve, they have the potential to change how care is delivered across the emergency department and throughout the entire hospital.

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