This article reviews and summarizes more than 200 studies regarding key issues surrounding the transition of elderly patients to or from the emergency department (ED), with particular attention paid to the relationship between the ED and nursing homes. Transfers of care often occur with incomplete information, which results in increased morbidity, recidivism, and cost. Transitions of elderly patients could be improved by standardizing hand-offs processes, improving discharge planning for elderly patients, developing metrics for transfers of care and geriatric care quality, and finding sustainable sources of research funding.
[Show abstract][Hide abstract] ABSTRACT: This study exposes a gap in patient safety that reflects challenges in information exchange and cross-setting communication. Research staff at the Muskie School of Public Service, with funding from the Agency for Healthcare Research and Quality, developed a demonstration project to document and standardize critical communication pathways and information between the nursing facilities (NF), emergency medical services (EMS), and emergency departments (ED) to reduce medication errors, delays in treatment, infections, and missing or misunderstood patient directives and consent.
[Show abstract][Hide abstract] ABSTRACT: Already crowded and stressful, US emergency departments (EDs) are facing the challenge of serving an aging population that requires complex and lengthy evaluations. Creative solutions are necessary to improve the value and ensure the quality of emergency care delivered to older adults while more fully addressing their complex underlying physical, social, cognitive, and situational needs. Developing models of geriatric emergency care, including some that are already in use at dedicated geriatric EDs, incorporate a variety of physical, procedural, and staffing changes. Among the options for "geriatricizing" emergency care are approaches that may eliminate the need for an ED visit, such as telemedicine; for initial hospitalization, such as patient observation units; and for rehospitalization, such as comprehensive discharge planning. By transforming their current safety-net role to becoming a partner in care coordination, EDs have the opportunity to become better integrated into the broader health care system, improve patient health outcomes, contribute to optimizing the health care system, and reduce overall costs of care-keys to improving emergency care for patients of all ages.
Health Affairs 12/2013; 32(12):2116-21. DOI:10.1377/hlthaff.2013.0670 · 4.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States.
The primary objective was to determine the number, distribution, and characteristics of geriatric EDs in the United States in 2013.
This was a survey with potential respondents identified via a snowball sampling of known geriatric EDs, EM professional organizations' geriatric interest groups, and a structured search of the Internet using multiple search engines. Sites were contacted by telephone, and those confirming geriatric EDs presence received the survey via e-mail. Category questions included date of opening, location, volumes, staffing, physical plant changes, screening tools, policies, and protocols. Categories were reported based on general interest to those seeking to understand components of a geriatric ED.
Thirty-six hospitals confirmed geriatric ED existence and received surveys. Thirty (83%) responded to the survey and confirmed presence or plans for geriatric EDs: 24 (80%) had existing geriatric EDs, and six (20%) were planning to open geriatric EDs by 2014. The majority of geriatric EDs are located in the Midwest (46%) and Northeast (30%) regions of the United States. Eighty percent serve from 5,000 to 20,000 elder patients annually. Seventy percent of geriatric EDs are attached to the main ED, and 66% have from one to 10 geriatric beds. Physical plant changes include modifications to beds (96%), lighting (90%), flooring (83%), visual aids (73%), and sound level (70%). Seventy-seven percent have staff overlapping with the nongeriatric portion of their ED, and 80% require geriatric staff didactics. Sixty-seven percent of geriatric EDs report discharge planning for geriatric ED patients, and 90% of geriatric EDs had direct follow-up through patient callbacks.
The snowball sample identification of U.S. geriatric EDs resulted in 30 confirmed respondents. There is significant variation in the components constituting a geriatric ED. The United States should consider external validation of self-identified geriatric EDs to standardize the quality and type of care patients can expect from an institution with an identified geriatric ED.
Academic Emergency Medicine 03/2014; 21(3):337-346. DOI:10.1111/acem.12332 · 2.01 Impact Factor
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