Geriatric screening in the ED cuts hospitalizations
Wednesday, January 17, 2018
Simply talking to a specially trained nurse in a quiet room, away from the chaos of the emergency department (ED), can prevent unnecessary hospitalizations in older adults. In fact, implementing such a transitional care program in three EDs reduced the risk of unnecessary hospitalizations by 33 percent, according to a new study.
About one-third of patients aged 65 and older who visit an emergency department in the United States wind up admitted to the hospital, according to the Centers for Disease Control and Prevention (CDC).
While admission is appropriate for patients in need of medical care, hospitalization can increase an older patient's risk of delirium, infection and falls. Many older adults experience a loss of independence, decline in functional ability and decrease in quality of life during and after hospitalization. Unnecessary admissions put these older patients at unnecessary risk for these serious hospital-acquired problems.
An innovative ED program, Geriatric Emergency Department Innovations (GEDI), aims to reduce unnecessary hospitalizations in older adults without putting the patient at risk for admission for a preventable incident.
Researchers at Northwestern University, St. Joseph’s Regional Medical Center, and Mount Sinai Medical Center hospitals wanted to study the GEDI program to determine whether such a system could reduce unnecessary hospitalizations in older adults. They also wanted to make sure the older patients were not being discharged from the ED only to be hospitalized for a preventable incident, such as a fall.
The team published their results recently in the Journal of the American Geriatrics Society.
Introduced in the three hospital emergency departments in 2013, the GEDI program focused on decreasing older patients' need for hospitalization following ED visits and preventing subsequent ED visits and readmissions in these patients. Studying the 57,287 patients has helped the three institutions learn more about the geriatric population, and learn how to address the needs of older adults without admitting them to the hospital.
The program at Northwestern staffs one or two GEDI nurses, a pharmacist and a social worker on weekdays between 9 a.m. and 10 p.m. GEDI nurses, trained in geriatric care, determined whether older patients in the ED were experiencing physical or mental decline, were having trouble caring for themselves at home, and if they had any age-related issues.
In some cases, the nurses would move the patients from the chaotic environment of the ED to a quieter, more comfortable room. The GEDI program at Northwestern has a space outside the ED, where the rooms feature nonslip, no-glare floors, doors rather than curtains, televisions and windows.
ED nurses assess older patients to determine if they are good candidates for the GEDI program. A patient who qualifies for the program receives one-on-one care from the GEDI nurse, who performs a cognitive assessment, reviews the patient's medical state and asks about any previous visits to the ED.
The GEDI nurse might also ask about the patient's support system at home and may even ask how the patient gets groceries. After discharge, nurses would place follow-up calls to the patients and offer appointments with social workers as needed.
The scientific review of the program found the system reduced the risk of unnecessary hospitalization of older patients by 33 percent. Specifically, only 36 percent of patients participating in transitional care ended up in the hospital, while 53 percent of those patients who did not participate were admitted.
The authors of the study hope it highlights the benefits of creating a geriatric-specific program for their emergency departments.
"This program is a model that other hospitals can easily adopt because they don't have to build a separate space," says Dr. Scott Dresden, co-author of the paper and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine, in a press release.
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