Health care systems worldwide are grappling with a 21st-century reality for emergency medicine: While we thought EM was primarily resuscitation, trauma, and procedures, it turns out that an increasing amount of our time is spent providing complex care to frail older people.1
Following the lead of ACEP, the Society for Academic Emergency Medicine, the Emergency Nurses Association, and the American Geriatrics Society, European leaders recently published a geriatric EM core curricula, and emergency nurses are acknowledging the need for a unique approach for the senior citizen in the emergency department.2–4 Seniors generally visit an ED more frequently than their younger counterparts, and they often present with more urgent and emergent conditions once in the ED. Both the number and nature of aging baby-boomer presentations to the ED could threaten access to care for patients of all ages unless leaders across disciplines devise more efficient strategies to integrate acute care during and following an ED visit.
Fortunately, innovations increasingly exist to overcome these challenges.5 ACEP Now reported on geriatric emergency department (GED) guidelines in 2014, endorsed by the ACEP Board of Directors, designed to inform staffing, education, protocols, and quality improvement initiatives to ED leaders.6 However, publishing alone isn’t enough to alter clinical practice across health care settings.
Thankfully, a diverse group of international stakeholders and funders is now providing innovative approaches to implement change. Could one of these approaches be the key to improving older-adult ED efficiency, patient-centric outcomes, and value-based purchasing for you?
United States: The Geriatric Emergency Department Boot Camp
All health care is local, as the saying goes; adapting the GED guidelines to fit local populations and available resources for a hospital and region is no exception.
Supported by grants from the John A. Hartford Foundation and the Gary and Mary West Health Institute, the Geriatric ED Boot Camp (led by Ula Hwang, MSc, MD, Kevin Biese, MD, MAT, Teresita Hogan, MD, Michael Malone, MD, and two authors of this article) has taken ED geriatric training to two health care systems over the last 18 months: Aurora Health Care in Wisconsin and the Magee-Womens Hospital of University of Pittsburgh Medical Center. Boot camp faculty worked intensively for six months with frontline ED nurses and physicians, hospital executives, and home health services to identify quality improvement (QI) opportunities across their EDs. The GED Boot Camp culminated in a two-day site visit to provide mentoring and coaching for the local teams, followed by six months of teleconference follow-up as the sites implemented individually selected QI projects to measure improved older-adult emergency care. The boot camp team is currently scaling up this approach to include at least nine hospital systems across the United States.
Canada: The Senior-Friendly Emergency Department Course
The Senior-Friendly ED (SFED) course has now been offered twice, in Toronto and Winnipeg, with attendance from 40 hospital teams across six provinces and four U.S. border states. In preparing for the SFED, individual hospitals send interdisciplinary teams of multiple individuals for a one-day intensive interactive learning program. This approach allows teams to identify challenges within their own institutions and realistic opportunities for improving older-adult patient outcomes and staff satisfaction. These courses not only focus teams on actionable problems but on interacting with other hospitals. This approach often reveals new opportunities for real-world solutions while simultaneously creating a team committed to achieving meaningful change at its own site.
Australia: Integrated Emergency Care for Older Persons Symposium
Because of professional silos, reimbursement issues, and the fast pace of an ED, linking vulnerable older patients with outpatient resources to reduce falls, address functional decline, and prevent unnecessary ED returns is challenging. EM alone cannot overcome these barriers. Clinicians, community providers, funders, and policy makers across the care continuum will converge in Melbourne, Australia, in October 2016 for a two-day scientific program aimed at identifying internationally relevant solutions for providing more integrated ED care. (You can find registration and program information at alfredetc-professional-development.cvent.com/IECOP.) The Integrated Emergency Care for Older Persons Symposium includes interactive roundtable debates, simulations, and original research presentations to alter practice in an innovative marketplace.