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Specialized EDs

April 11, 2012
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Can EDs for the Elderly Help Improve Care Transitions?

An interesting article in yesterday’s New York Times described what it says is part of a growing trend in healthcare: trying to cater to the medical needs of elderly patients. A few months ago Mount Sinai Medical Center opened its first geriatric ED, which was modeled on one at St. Joseph’s regional Medical Center in Paterson, N.J., according to the Times. Mount Sinai maintains that its geriatric ED is the first one of its kind in New York City.

[For a design perspective on what healthcare organizations are doing to accommodate seniors, both inside and outside the ED, turn to our sister publication, Healthcare Design, which has just published a feature on the topic.]

Among the EDs amenities are skid-proof floors, dimmable lighting and mattresses that help prevent bedsores. Some rooms are equipped with tablet computers that patients can use to contact the nursing station. As described in the Times article, the iPad has been nicknamed a “geriPad,” which lets patients have a two-way video conversation with a nurse or touch the screen to ask for pain medication, music or lunch. A team of caregivers physicians, nurses, support staff, and volunteers work together to make elderly patients more comfortable during their hospital stay.

People over age 65 account for 15 to 20 percent of ED visits, according to the article, a significant population from a financial standpoint, given that Medicare payments will be tied to scores on patient satisfaction surveys and hospital readmissions.

According to Mount Sinai, this approach will lead to better clinical outcomes due to improved coordination of care. The Times notes that up to 27 percent of older patients who are admitted to an ED have another emergency, are admitted to the hospital or die within three months of being sent home.

The idea of geriatric EDs has its skeptics. One is the chief of emergency services at a New Jersey hospital, who believes geriatric EDs are a distraction to giving optimal treatment to all patients, regardless of age, according to the Times. But St. Joseph’s, which opened a geriatric ED in 2009, has been able to reduce unscheduled visits to the ED to 1 percent from 20 percent.

This is an idea worth exploring. Having a care team in place to pay special attention to elderly patients, can help remove some of the roadblocks to good care transitions, by explaining new medications to patients, looking out for drug interactions, or following up with the patient in their homes after discharge. I think elderly patients are a population with special needs that aren’t being met with conventional emergency departments.