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Simple Changes for Boosting ER Throughput

   September 18, 2015

"We saw this as a way to provide better service at the local level for seniors but also to show a regional Trinity Health approach and customize at each of the communities," says Ray Gibbons, FACHE, CEO of Saint Alphonsus Medical Center-Baker City, a 25-bed critical access hospital in Oregon. It's part of the St. Alphonsus Health System, which is setting up four additional senior emergency rooms at its facilities.

Gibbons says his hospital is building on concepts tested by Holy Cross and implementing them locally, such as quieter areas, better lighting, and softer colors on the wall. The patient population specific to the Baker City facility is a natural fit for senior emergency rooms, says Gibbons.

Ray Gibbons, FACHE

"In our communities, the seniors' families—adult children—they're not in the community anymore; they're far away," he says. "So we have trained the emergency room staff to use words that are comforting to the patient, to frame a question better, establish compassion, and know when to take a pause and listen."

Since opening its first SEC at Holy Cross Hospital, Trinity Health has gleaned what Penoza says is valuable information about the senior population. For example, Holy Cross uses a risk-assessment tool
in its SEC to get information about medication, recent falls, mental status, and daily living activities.

"We found 17.4%–20% of patients age 65 and older admitted to the ER are from a senior facility," Penoza says. "Why is this important? Clinicians need to understand what types of services are available in the senior facility to generate referrals appropriately."

That risk assessment also is used by a social worker to follow up with patients when they are discharged from the SEC. Eig credits the social worker follow-up for a large part of the SEC's success at Holy Cross.

"The service being provided by the social work has, besides leading to greater satisfaction for our patients, also ensured better follow-up for patients, whether it is in a physician's office, with medication, etc. That has lowered readmissions for that patient population."

As far as the effect on the overall ED throughput at Holy Cross Hospital, Eig says it increased ED volume because the word was out in the community that the resource existed, but the segmentation allowed for better throughput overall in the ED.

"By taking the seniors to an area off the main ER, it freed up space in the main ER for managing more acute cases and younger patients," says Eig. "It also allowed more time for seniors. It often takes more time to evaluate, treat, and either admit or release seniors."

EDs set up specifically for seniors are not widespread, but they may be more common as the population ages and hospitals look for population health strategies.

Reprint HLR0515-6

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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