Concepts in Practice: Geriatric Emergency Departments

Southerland, Lauren T.; Lo, Alexander X.; Biese, Kevin; Arendts, Glenn; Banerjee, Jay; Hwang, Ula; Dresden, Scott M.; Argento, Vivian; Kennedy, Maura; Shenvi, Christina; Carpenter, Christopher R.

doi:10.1016/j.annemergmed.2019.08.430

Cited by 70 publications

(57 citation statements)

References 47 publications

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“…In other models of care, additional night staffing would be required. 7 Expanding staffing coverage to weekends and evenings could change revenue calculations, as a pay differential may be required for additional coverage.…”

Section: Discussionmentioning

confidence: 99%

“…The ED received Level 1 GED accreditation in August 2018 for a geriatric-focused ED observation unit (EDOU), with multidisciplinary assessments performed in the EDOU. 7 The EDOU is a 20-bed unit confluent with the ED, and ED patients are cared for in that space as well if beds are not filled by observation patients. This is a model of GED care where all the ED staff receive geriatric education and there is geriatric equipment available for the entire ED.…”

Section: Settingmentioning

confidence: 99%

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Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Southerland

Savage

Duff

et al. 2020

Academic Emergency Medicine

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Objectives: The American College of Emergency Physicians' geriatric emergency department (GED) guidelines recommend additional staff and geriatric equipment, which may not be financially feasible for every ED. Data from an accredited Level 1 GED was used to report equipment costs and to develop a business model for financial sustainability of a GED. Methods: Staff salaries including the cost of fringe benefits were obtained from a Midwestern hospital with an academic ED of 80,000 annual visits. Reimbursement assumptions included 100% Medicare/Medicaid insurance payor and 8-hour workdays with 4.5 weeks of leave annually. Equipment costs from hospital invoices were collated. Operational and patient safety metrics were compared before and after the GED. Results: A geriatric nurse practitioner in the ED is financially self-sustaining at 7.1 consultations, a pharmacist is self-sustaining at 7.7 medication reconciliation consultations, and physical and occupational therapist evaluations are self-sustaining at 5.7 and 4.6 consults per workday, respectively. Total annual equipment costs for mobility aids, delirium aids, sensory aids, and personal care items for the GED was $4,513. Comparing the 2 years before and after, in regard to operational metrics the proportions of patients with lengths of stay > 8 hours and patients placed in observation did not change.

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Section: Discussionmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Southerland

Savage

Duff

et al. 2020

Academic Emergency Medicine

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“…One operational model of multidisciplinary assessment in the ED uses an observation unit (Obs Unit) [30]. Obs Units are a promising solution to these barriers.…”

Section: The Consolidated Framework For Implementation Researchmentioning

confidence: 99%

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

Southerland

Mion

Moffatt-Bruce

et al. 2020

Implement Sci Commun

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Background: Older adults in the emergency department (ED) are at high risk for functional decline, unrecognized delirium, falls, and medication interactions. Holistic assessment by a multidisciplinary team in the ED decreases these adverse outcomes and decreases admissions, but there are many barriers to incorporating this type of care during the ED visit. Methods: This is a hybrid type II effectiveness-implementation study using a pre-/post-cohort design (n = 380) at a tertiary care academic ED with an ED observation unit (Obs Unit). The intervention is a two-step protocol of (step 1) ED nurses screening adult patients ≥ 65 years old for geriatric needs using the Delirium Triage Screen, 4-Stage Balance Test, and the Identifying Seniors at Risk score. Patients who have geriatric needs identified by this screening but who do not meet hospital admission criteria will (step 2) be placed in the Obs Unit for multidisciplinary geriatric assessment by the hospital's geriatric consultation team, physical therapists, occupational therapists, pharmacists, and/or case managers. Not all patients may require all elements of the multidisciplinary geriatric assessment. The Consolidated Framework for Implementation Research: Care Transitions Framework was used to identify barriers to implementation. Lean Six Sigma processes will be used to overcome these identified barriers with the goal of achieving geriatric screening rates of > 80%. Implementation success and associated factors will be reported. For the effectiveness aim, pre-/post-cohorts of adults ≥ 65 years old cared for in the Obs Unit will be followed for 90 days postED visit (n = 150 pre and 230 post). The primary outcome is the prevention of functional decline. Secondary outcomes include health-related quality of life, new geriatric syndromes identified, new services provided, and Obs Unit metrics such as length of stay and admission rates.

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“…They are also more likely than younger adults to have adverse outcomes after ED discharge . High‐quality ED care has the potential to make a dramatic impact on an older adult’s health, both in managing their acute complaint and in potentially identifying and intervening to address functional decline.…”

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confidence: 99%

Geriatric Emergency Medicine Fellowships: Current State of Specialized Training for Emergency Physicians in Optimizing Care for Older Adults

Rosen

Liu

Cameron-Comasco

et al. 2020

AEM Education and Training

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Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and From the content. SWL contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information, manuscript initial drafting, and critical revision of the manuscript for important intellectual content. LCC contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information, manuscript initial drafting, and critical revision of the manuscript for important intellectual content. SC contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. KB contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. PM contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. KRT contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. DM contributed to ideas, content, and structure of this concept paper; provided information about fellowship experience; and participated in synthesis of information and critical revision of the manuscript for important intellectual content. PT contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. TW contributed to ideas, content, and structure of this concept paper and participated in synthesis of information and critical revision of the manuscript for important intellectual content. NME contributed to ideas, content, and structure of this concept paper and par...

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Concepts in Practice: Geriatric Emergency Departments

Cited by 70 publications

References 47 publications

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Study protocol for IMAGE: implementing multidisciplinary assessments for geriatric patients in an emergency department observation unit, a hybrid effectiveness/implementation study using the Consolidated Framework for Implementation Research

Geriatric Emergency Medicine Fellowships: Current State of Specialized Training for Emergency Physicians in Optimizing Care for Older Adults

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