The Geriatric Emergency Department

Transcription

1 The Geriatric Emergency Department Mark Rosenberg, DO, MBA, FACEP, FACOEP-D, FAAHPM Associate Professor, Emergency Medicine, New York Medical College, Valhalla, NY Chairman, Department of Emergency Medicine Medical Director, Population Health St Joseph s Healthcare System, Paterson, NJ Innovations: GED, ED Palliative Care, ALTO, ED Population Health Board of Directors, ACEP Board of Directors EMF 1

2 St. Joseph s Regional Medical Center 641-bed tertiary care teaching hospital Paterson, NJ Emergency Department ,000 total visits/year: 41,000 Pediatric Emergency Department 28,000 Geriatric Emergency Department 24 Bed Unit 200 Emergency Department Palliative Medicine 2 LSMA Rooms Comprehensive stroke center Trauma center Resuscitation center Heart Failure center Toxicology reference center Life Sustaining Management and Alternatives (LSMA) 2

3 Making the Case for a Geriatric ED 3

4 Population >65 years by size and % of total population 4

5 ED utilization rates for seniors 7x more usage of ED services 43% of all admissions 48% of all Critical Care admissions 20% longer length of stay 50% more lab 50% more radiology 400% more social service interventions CMS 2008 Data Set 5

6 The Geriatric ED Difference 6

7 A GED is Designed for the Functionally Independent Healthy Feel great Exercise daily Eat right Drink socially Very social Controlled Health Issues MI within past two years High BP High cholesterol Prostate Cancer Osteoarthritis On six medications Countless vitamins Contact lenses Hearing aids 7

8 Two paradigms Non-geriatric ED Patient Single complaint Acute Diagnose and treat Rapid disposition Geriatric ED Patient Multiple problems Medical Functional Social Acute on chronic, subacute Control symptoms, maximize function, enhance quality of life Continuity of care 8

9 The Geriatric Patient Encounter Mrs. Smith is a 78 y/o functionally independent senior. She lives alone and daughter lives 2 blocks away. This AM, Mrs. Smith hurt her ankle going down the steps. Has difficulty ambulating. 9

10 The Geriatric ED Difference The GED Difference Adult ED H and P Order X-Ray Geriatric ED H and P Order X-Ray 10

11 The Geriatric ED Difference The GED Difference Adult ED H and P Order X-Ray Reevaluation Discharge Geriatric ED H and P Order X-Ray 11

12 The Geriatric ED Difference The GED Difference Adult ED H and P Order X-Ray Reevaluation Discharge Geriatric ED H and P Order X-Ray Seen by GED Team PT Social Work Nutrition Geri RN Pharmacy Geriatric Screenings Discharge Planning Transition of Care 12

13 The Geriatric ED Difference The GED Difference Adult ED H and P Order X-Ray Reevaluation Discharge Geriatric ED H and P Order X-Ray Seen by GED Team PT Social Work Nutrition Geri RN Pharmacy Geriatric Screenings Discharge Planning Transition of Care Home Assessment 13

14 The Geriatric ED Difference The GED Difference Adult ED H and P Order X-Ray Reevaluation Discharge Also Senior Patient Has Phone Reassessment on Day 1,3, 7, and day 30 Geriatric ED H and P Order X-Ray Seen by GED Team PT Social Work Nutrition Geri RN Pharmacy Geriatric Screenings Discharge Planning Transition of Care Home Assessment 14

15 Outcomes Increased patient satisfaction Higher rate of postdischarge independence Fewer return visits Lower admission and readmission rate Improved screening for inappropriate medications Increased patient volume 15

16 The GED Guidelines 16

17 Nationally More than 180 Geriatric EDs and growing finally there is a standard. Accreditation Standard and Minimal Requirements Development ACEP AGS ENA SAEM JCAHO and DNV 17

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21 Geriatric ED Accreditation 21

22 Why If not us then who? Makes your job easier - Members Better care for seniors Patients Better for ACEP Where would you want your mom to go 22

23 7 Domains of a GED 23

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27 2. Quality initiatives 1. FALLS ASSESSMENT and PREVENTION Falls risk assessment Get-up-and-go testing 2. MEDICATIONS Drug interactions 5 Meds = 70% chance of drug interactions 7 Meds = 100% chance of drug interaction Beers criteria AGS 2012 Potentially inappropriate medication use in older adults 3. GERIATRIC SCREENING Dementia, Delirium, Depression, Nutrition, Falls ISAR 27

28 8. Patient Satisfaction/Value Based Purchasing Address Patient by preferred name Patient liaison Blankets Reading glasses Hearing assist devices Nutrition Food Snacks Coffee and Tea Space for Family Holistic Medicine 28

29 M Holistic Medicine Reiki Energy d4qgz5 Bzo&fea ture=pl ayer_detailpa ge#t=3 5s Pranic Healing Energy Aroma Therapy IDpscnLw&feat ure=pla yer_de tailpag e Acupressure Music Therapy Medical Harp Therapy Light Therapy 29

30 Putting it all together Evelyn and Stanley s Story 91+88=Priceless 30

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32 Three Day Later on a Date...

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34 Stanley s Story.. House Sitting Pet Sitting Minor Home Repairs

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36 The Downward Spiral Depression Weight Loss More Injury Role of the Geriatric ED Strength Nutrition Palliative Care Hospice

37 We All Have Goals.. Please, Can We Dance Again

38 Add 6 People 4 Cars 2 Wheel Chairs One Walker Two Canes One Doctor 38

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40 One Year Latter Evelyn Weight Independent Stanley Driving

41 The Geriatric ED! If not us then who? The Time is Now!

42 The GED Team 42

43 This is dedicated to the ones we love 43

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