Geriatric emergency departments at hospitals have implications for long-term care

Older adults use emergency department (ED) services more frequently than younger people, and an aging population means that the ED designed solely for elderly patients is one of 10 technology-related trends hospital leaders and others will be thinking about this year. That’s according to the nonprofit ECRI Institute’s 2014 Top 10 Hospital C-Suite Watch List.

More than 50 elderly-focused EDs have opened in the United States since 2011, the report notes, and another 150 are being planned. For those working in long-term care, the trend could have implications related to hospital readmissions and the use of LTC facilities.

Infrastructure/structural redesign of the ED as well as new protocols and care processes, including training ED staff in geriatric patient care, can improve clinical outcomes in older adults and reduce intensive care stays and readmissions, report authors say. For instance, the 30-day post-ED return rate for seniors (for the same condition) dropped from 20 percent to less than one percent at St. Joseph’s Regional Medical Center in Paterson, NJ, one year after it opened its geriatric ED in 2009, according to the report.

EDs for the elderly—separate spaces as well as those carved out of existing EDs—can have layouts, nonskid floors, handrails, aisle lighting and bedside commodes to reduce fall risk; wider and thicker mattresses and other furniture to prevent pressure ulcers; nonflorescent lighting, windows and other aids to help with orientation; and noise abatement features to aid communication with hearing-impaired adults, according to the report. Elderly-focused EDs also can offer services to address challenges faced by seniors spending time in such facilities—medical complications, functional decline and poor health-related outcomes, the authors add. Such services could include screening for cognitive impairment and delirium as well as a nursing discharge coordinator to improve continuity of care and reduce the risk of a return visit. Care protocols and processes can minimize the use of urethral catheters and other equipment that decrease mobility and increase the risk of infection and delirium.

The publication is available at no charge at the ECRI Institute website. Registration is required.

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