Geriatric ERs: Golden idea for golden years?
By Dorothy L. Tengler

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We have all visited the emergency department at least once or have accompanied a family member or friend. And once is enough to remember the often chaotic atmosphere — beeping monitors, bright lights, loud voices and healthcare personnel scurrying about — not to mention the often long wait followed by rapid triage. For older patients, the ED can be a very confusing and frightening experience.

INDUSTRY PULSE

Is your ED considering a geriatric division?
  • 1. Yes
  • 2. No

In fact, older patients visit the ED more than any other age group except infants, and the aging population will increase as baby boomers continue to enter the 65-and-older age bracket. For years hospitals have set up separate ERs for kids, but only in the past few years have hospitals begun to consider setting up EDs for elderly patients. Research shows older patients have different patterns of ED use and therefore different needs than younger patients. Geriatric patients incur a higher number of visits, more urgent visits, longer visits, more frequent return to the ED and higher rates of complications.

In 2008, Holy Cross Hospital in Silver Spring, Md., opened one of the first geriatric EDs, called a Seniors Emergency Center. Holy Cross Hospital's parent organization, Trinity Health System, runs 12 nationwide, mostly in the Midwest, with plans to have opened about seven more by June 2012.

At Mt. Sinai in Manhattan, N.Y., senior patients arriving at the ED go through triage in the regular ED and are then sent to the geriatric department if they are over 65, know their name, were able to walk before the day of the hospital visit and are ranked 3-5 on a standard emergency severity index of 1 to 5, with 1 being the most ill.

The geriatric ED consists of eight beds and six examining rooms that resemble a clinic more than an emergency room — nonskid floors, rails along the walls, reclining chairs for patients and thicker mattresses to reduce bedsores. Curtain rings and rods around the beds are made of plastic instead of metal to reduce noise. One exciting innovation at Mt Sinai's geriatric ED is a geriPad, an iPad that lets patients have a two-way video conversation with a nurse or touch the screen to ask for lunch, pain medication or music.

While all of this sounds very cozy and comfortable, there are real benefits for geriatric EDs:
  • Patient-centered (Increased patient satisfaction)
  • Improved screening for inappropriate medications
  • Reduced hospital admissions/readmissions
  • Fewer ED visits
So, why aren't geriatric EDs more common? Some hospitals are reluctant to commit the space, especially if their EDs are already overcrowded. Other hospitals are concerned about the cost at a time when Medicare and Medicaid reimbursement is decreasing. Doctors and nurses may consider assignments to a geriatric ED as "scut" work.

Other skeptics see geriatric EDs as a distraction from the goal of giving optimal treatment to everyone. Dr. Alfred Sacchetti, chief of emergency services at Our Lady of Lourdes Medical Center in Camden, N.J., said he had not seen evidence that geriatric ERs provided better outcomes for patients. But to the degree they did improve care — for example, if the thicker mattresses did cut down on bedsores — then those improvements should be extended to all emergency patients.

Finally, there is the question of training. The needs of the elderly are significantly different than those of younger patients. The nature and extent of geriatric training currently provided to emergency medicine residents needs to be identified. Although geriatric emergency care is becoming an integral part of the emergency medicine residency program, there may be a need for better focused and more intensive training.

Emergency physicians face daily challenges providing care to the growing geriatric population. But will geriatric EDs be a standard design in hospitals of the future? The jury is still out.

Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, primary and review manuscripts, and pharmaceutical sales training materials.

References

  • Hogan TM, Losman ED, Carpenter CR et al. Development of geriatric competencies for emergency medicine residents using an expert consensus process. Acad Emerg Med. 2010 Mar;17)3):316-24.
  • Anemona Hartocollis. For the elderly, emergency rooms of their own [online accessed April 2013]
  • Hwang U, Morrison RS. The geriatric emergency department. J Am Geriatr Soc. 2007 Nov;55(11):1873-6.
  • Diane C. Lade. Emergency rooms specially designed for seniors. [online accessed April 2013]
  • Dr. Jessica Noonan. For the elderly, a new kind of ER [online accessed April 2013]
  • Biese KJ, Roberts E, LaMantia M et al. Effect of a geriatric curriculum on emergency medicine resident attitudes, knowledge, and decision-making. Acad Emerg Med. 2011 Oct;18 Suppl 2:S92-6.