Many hospital emergency departments (EDs) have specialty areas for children. Now some are developing separate areas for seniors with geriatric team-based care, more comfort, and less noise and confusion. The focus of the specialized team is to not just treat the immediate problem, but to uncover underlying problems ― from depression to dementia to a hazard-prone home environment. Seniors already account for more than million ED visits a year and by 2030, 20 percent of all Americans will be 65 or older. Older adults have different needs which are often at odds with modern EDs that are best equipped to handle crises like gunshot wounds or car crashes. Geriatric patients often need lengthy detective work to unravel the multiple ailments that they tend to show up with and may exhibit different symptoms than younger people. Their illnesses may cause confusion that can be mistaken for dementia. At the same time, cognitive problems may not be obvious when these patients are describing their symptoms or the onset of their medical problem. Seniors also have a high rate of recurrent visits to the ED.
HOW DOES IT WORK
Seniors still enter through the main ED and initially visit the triage nurse. If they have an immediate, life-threatening condition they stay in the regular ED. Otherwise they are triaged to the adjacent geriatric ED intake area.
Specific features of the geriatric ED include:
- Treatment spaces are designed with doors instead of curtains to reduce noise that can increase anxiety, cause confusion, and create communication difficulties.
- Nurses carry “pocket talkers” ― small amplifiers that hook to headphones so they don’t have to yell if a patient is hard of hearing.
- Stretcher mattresses are thicker and patients who do not need to lay flat can opt for cushioned reclining chairs instead (patients tend to feel better when they can remain upright).
- Nonskid floors and strategically-placed handrails guard against falls.
- Dimmable task and overhead lighting are provided.
- Forms are printed in large type ― to help patients read their care instructions when it is time to go home.
- Pharmacists automatically check if the patient’s routine medications could cause dangerous interactions.
- A geriatric social worker is on hand to arrange for Meals on Wheels or other resources.
- Day-after-discharge follow-up phone calls are conducted to monitor how patients are doing after discharge.
The real change in patient care involves retraining physicians and nurses to delve deeper into patients’ lives ― such as checking for signs of depression, dementia, or delirium while they are awaiting test results.
Older adults have different needs which are often at odds with modern EDs that are best equipped to handle crises like gunshot wounds or car crashes.
It should be noted that hospitals with enough money and space may have an advantage but the key is staff training to improve overall geriatric awareness regardless of whether a separate specialty ED is created. One key measure of the success of an organization’s investment of dollars and time is a reduction in return visits.
This article is an update from a previous post.