Geriatric ER popularity grows to meet demand

The number of emergency departments (EDs) dedicated to caring for older adults will likely grow over the next 18 months in order to provide better healthcare, address population health and reduce costs, experts told AMN Healthcare.

The ECRI Institute estimates about 50 geriatric EDs are in operation in the United States and another 150 are in development. The growth is necessary to meet the needs of the number of Americans aged 65 or older, which will reach 89 million by 2050. Older adults make up a quarter of all ED visits, according to the AMN article.

The Geriatric Emergency Department Innovations through Workforce, Informatics and Structural Enhancements (GEDI-WISE) project received a 12.7 million grant from the Department of Health and Human Services to set up geriatric emegericy rooms (ER) at several locations. Its main site is at the Mount Sinai School of Medicine in New York City but each location will operate differently.

For example, at the GEDI-Wise model at Northwestern Memorial Hospital in Chicago, clinicians with geriatric care training treat patients in the general ER, but offer additional screening for age-related conditions. Admissions have decreased from 43 percent to 27 percent since April 2013, Amer Z. Aldeen, M.D., assistant professor in emergency medicine at Northwestern University Feinberg School of Medicine, told AMN.

Other geriatric ERs report successes as well. St. Joseph's Regional Medical Center in Paterson, N.J., saw its 30-day post-ED same-condition return rate for seniors decrease from 20 percent to less than 1 percent in the year after it opened the separate senior ED. "It's not just the environment but the follow-through and transition of care," Mark Rosenberg, M.D., chairman of emergency medicine and chief of geriatric medicine and palliative care at the hospital, told AMN. "It has worked out great. We would never go back. This is our new way of doing business."

The majority of changes necessary for implementing a successful geriatric ED are physical ones, Healthcare Design magazine reported. Soft colors, large-face clocks, calendars and patient boards, and nonskid floors and handrails create a more effective environment for treating geriatric patients.

The changes are essential, considering ED visits can negatively affect older patients with complex conditions, which often worsen aft their visits, according to a 2013 study published in the Annals of Emergency Medicine, FierceHealthcare previously reported. Before arriving, 46 percent of the elderly patients required help for daily activities--a number that rose to 67 percent at the ED. Moreover, about 48 percent of patients already had a geriatric syndrome, such as immobility, confusion and incontinence, before visiting the ED. After their visit, about 78 percent had a geriatric syndrome.

To learn more:
- here's the AMN article
- read the Healthcare Design piece
- check out the ECRI report (.pdf)