Senior-friendly emergency care

The percentage of Americans age 65 and over is growing, from 14% in 2012 to an estimated 20% by 2030, according to the
Centers for Disease Control and Prevention (CDC). As the aging population grows, so does the number of visits to the emergency department (ED) by this demographic.
Nationwide, EDs are tailoring their processes and environments to better accommodate older adults. Sharp HealthCare expects to see the number of visits to the ER by people 65 and older to grow over the next decade. Recently, three Sharp hospital emergency departments were recognized for their efforts in enhancing the care and resources they provide to older people.
Sharp Coronado Hospital and
Sharp Memorial Hospital emergency departments received Bronze Standard Level 3 accreditation and Sharp Grossmont hospital received Gold Standard Level 1 accreditation from the American College of Emergency Physicians (ACEP), for the high standard of emergency care they provide to the geriatric population.
"Receiving the geriatric ED accreditation further aligns us with our commitment to providing the highest level of person-centered care to an aging population," says Marla Poston, director of patient care services at Sharp Coronado Hospital. "We are focused on creating a sustainable health care model for older adults so that they not only live longer, but also live happier and healthier."

This new approach puts the focus on the big picture, from the front door to discharge and beyond, and shows a commitment to ensuring our community receives the highest-quality care.

"This recognition is important because it identifies the efforts our ED has made to assure age appropriate care," says Josh McCabe, director of emergency services at Sharp Memorial. "As we all increase in years, our health care needs will change. It is important that hospitals, physicians and nurses appreciate those changes, and adapt the care and treatment provided to assure quality care at any age."
Levels of care
ACEP's voluntary program includes three levels of accreditation, and provides specific criteria and goals for emergency clinicians and administrators to target. The accreditation process includes more than two dozen best practices, and the level of accreditation achieved depends upon how many of these are met.
To earn Level 1 and 3 accreditations, respectively Sharp Grossmont, Sharp Coronado and Sharp Memorial incorporated many of these best practices, including having geriatric-appropriate equipment available, as well as specialized staff and more routine screening for vulnerabilities such as delirium, dementia and fall risk.

At Sharp Coronado, the focus is on efficiency and putting the patient at ease.

"The patient's entire care team is present to take the patient's history and medication list so that the patient only has to do so one time," says Elisabeth Green, manager of the emergency department at Sharp Coronado Hospital. "The patient bypasses the triage area and goes directly to a patient bed, so they don't have to move multiple times."  

"Being a Level 1 emergency department means that we place an emphasis on best practices for older adults to help make a visit to the ED less stressful," says Julie Dye, clinical nurse specialist in Sharp Grossmont's emergency department. "Our goal is to improve the behind-the-scenes work on guidelines of care that optimize outcomes for older adults."

To achieve the highest level of accreditation offered by ACEP, the Sharp Grossmont emergency department updated their physical environment, use dedicated nursing staff trained in performing advanced geriatric assessment, and collaborate between departments, such as physical and occupational therapy, social work, pharmacy and advanced illness management.   
Sharp Grossmont's emergency department has a physician champion with specialized geriatric education, as well as geriatric specialty-trained nurses to address the unique physical and cognitive changes as people age.
"For example, we have learned that early mobility can help seniors avoid developing hospital-related delirium," says Dye. "Training was provided to the nursing staff to encourage early walking and offering food and beverages, as well as judicious use of medications associated with risk of delirium and use of restraints in older adults."
Some specific features an older adult may find when visiting the emergency department at Sharp Grossmont include:

• Quicker times to evaluation by a provider

• Single occupancy rooms

• Gurneys with extra thick mattresses, to provide comfort and reduce risk of skin breakdown

• Warmed blankets

• Sound amplifiers

• Processes to avoid use of urinary catheters

• Magnifying glasses for those patients who may not have their eyeglasses with them

Moving forward
Sharp Coronado and Sharp Memorial are in the process of working toward higher level accreditation. For Sharp Memorial, this involves new architecture.

"Currently, we are working on designs for a new emergency department and hospital tower, and we are keeping senior care in mind," says McCabe. "We are working with the architectural teams to create more natural light, quieter rooms and improved safety designs to help us provide age appropriate care."
Sharp Coronado plans on remodeling its emergency department, which will help qualify it for Level 1 Gold accreditation.
"We are about to embark on an exciting expansion project where we will double the size of our ED," says Green. "In the design process, we are making sure that the environment and layout we create are geriatric-friendly."
The staff in all three emergency departments share the common goal of ensuring that the older population they serve feel that all their specific needs are met in a comfortable environment.
"We continue to improve patient outcomes in the ED, standardize how we care for common geriatric issues, and optimize transitions of care from the ED to other settings," says Dye. "These efforts will ensure that when our older patients see us, they can be confident that they are receiving optimal care and treatment catered to their needs."