How to Improve Care for Geriatric Patients in the Emergency Department

Doctor Talking To Senior Female Patient In Wheelchair

As the population ages and life expectancies increase, there’s now, more than ever, a need within emergency departments for care tailored specifically for geriatric patients. The U.S. Department of Health and Human Services’ Administration on Aging (AoA) notes more than 46 million people in the country are age 65 or older — over 14 percent of the entire U.S. population. That number is expected to rise to 22 percent by 2040 and double to 98 million people 65 and older by 2060.  

The health and well-being of this segment of the population will continue to be a concern for the healthcare industry as a whole, with emergency departments continuing to serve as an important point of access to care.

Currently, only 44 percent of men and women 65 and older characterize their level of health as excellent or very good, and most seniors have at least one chronic condition, if not more. According to the AoA, arthritis and heart disease were most common, with 49 percent and 30 percent of older Americans experiencing these conditions, respectively. Even more telling, nearly 7 million people age 65 and older spent at least one night in the hospital in 2014.

In collaboration with The American Geriatrics Society, Emergency Nurses Association, and the Society for Academic Emergency Medicine, the American College of Emergency Physicians (ACEP) has developed a set of guidelines for EDs to follow to improve care for geriatric patients. If you’re an ED or hospital leader wanting to effectively refine the quality of care geriatric patients presenting to your ED receive, consider implementing these strategies as outlined by ACEP:

Staffing and Education

Emergency departments with high volumes of geriatric patients may want to consider employing dedicated staff and leadership trained in geriatric care. Depending on hospital resources, these positions could be filled with physicians and nurses with specialized training as well as ancillary service providers, such as occupational and physical therapists.

Education is another way to train your current team in understanding the needs of your elderly patients. Hospital leaders may want to consider developing  training programs to increase awareness among staff about how to provide the highest quality of care to geriatric patients or encourage staff to take part in continuing education or outside programs focused on geriatric care.

Follow-up Care

Effective communication is often key when it comes to patients — no matter their age — successfully receiving follow-up care after an ED visit. ACEP notes, “Older ED patients identify misinformation as a primary course of dissatisfaction with their emergency care, a problem confounded and magnified by ongoing under-recognition of cognitive dysfunction, lower health literacy, and financial impediments for prescriptions and recommended outpatient follow-up.”

When EDs ensure discharge instructions are relayed to patients and caregivers –– along with pertinent information about treatment and continuity of care –– geriatric care will improve significantly, and satisfaction will increase. ACEP recommends delivering the following facts, figures, and information to patients at discharge:

·      Presenting complaints

·      Test results and interpretation

·      ED therapy and clinical response

·      Consultation notes (in person or via telephone) in ED

·      Working discharge diagnosis

·      ED physician note, or copy of dictation

·      New prescriptions and alterations with long-term medications

·      Follow-up plan

·      Clinical information will be presented in a format in a way best suited for older adults

·      Large font discharge instructions

·      Health Insurance Portability and Accountability Act (HIPAA) compliant copied discharge instructions should be provided to family and care providers.

Equipment

The type of equipment and supplies utilized by EDs have a great effect on the quality of care a geriatric patient receives. Consider making exam chairs more comfortable and accessible for older patients and using soft, moisture-proof upholstery. Special equipment such as warm blankets, non-slip mats, and walkers are also valued and appreciated by geriatric patients and their caregivers. Small touches such as painting the wall with light, non-glare paint, soft overhead lighting, and allowing natural light to fill rooms also go a long way to improve the well-being of elderly patients.

The benefits of improving the quality of care geriatric patients receive in your ED are great. EDs with care plans tailored for senior citizens can expect an increase in patient satisfaction scores, staff morale, and increased patient safety. I discussed just a few strategies hospital and ED leaders should take based on ACEP’s guidelines. If you’re interested in learning more about what your ED can do to serve geriatric patients better, feel free to schedule a complimentary phone consultation with me to discuss in detail additional steps you and your team may want to take.

SOURCES:

U.S. Department of Health and Human Services Administration for Community Living: Administration on Aging (AoA) Aging Statistics

U.S. Department of Health and Human Services Administration for Community Living: Administration on Aging (AoA) Profile of Older Americans: 2015

American College of Emergency Physicians: Geriatric Emergency Department Guidelines