Hospital admissions have always been a major concern for senior living providers, but they are even more so today to communities that are serving an older, frailer population than in years past.
With the Centers for Medicare and Medicaid Services (CMS) tracking readmissions in some care settings and better systems in place today for measuring hospital admissions and readmissions among the senior population, the topic has become paramount. So much so that major health organizations are exploring the benefits of senior-specific emergency rooms.
One such system is the University of California, San Diego, which operates multiple hospital campuses in greater San Diego, and through grant funding of $12 million from San Diego-based West Health, is under way with plans to build such an emergency room.
The $14 million 8,500 square foot project anticipates completion in 2018.
Current emergency medical facilities do not have the capacity to serve the wave of senior patients that is coming via the “silver tsunami,” said Dr. Ted Chan, chair of the Department of Emergency Medicine at UC San Diego, during a recent MedCity Engage conference.
“When we look at the numbers in emergency medicine, there is one emergency department visit for every two folks over the age of 65,” he said on a panel during the conference in La Jolla, Calif. “That’s over 500 visits per 1000 people over 65… as the population grows, we imagine that will grow. It’s a significant challenge.”
There are currently around 100 emergency rooms nationwide that market themselves as geriatric ERs, Chan said, although few are taking such a comprehensive approach as UCSD’s. The university is collaborating in its research with a couple of figureheads when it comes to geriatric ERs, including Northwestern Memorial Hospital in Chicago and Mt. Sinai Hospital in New York City.
The approach to developing a senior-specific ER involves both research and data analysis, says Dr. Zia Agha chief medical officer for West Health.
“On the research side we are doing research with UCSD and on a national level,” he says. “We are looking at data from three EHRs. One initiative is to create a data warehouse, allowing more rapid cycle research. Also looking at using data as an opportunity to create quality measures.”
Defining the senior-centric emergency room
In very loose terms, a geriatric ER is on that has specific accommodations for senior patients. This could mean materials used for flooring that can help prevent falls, for example. The UCSD project, which will break ground in 2017, is also looking at a number of other elements: ample windows for natural light; ambient light that will prevent patients from becoming disoriented; acoustics and sound absorption to help patients who are hard of hearing; considerations for mobility issues including fall prevention; and ample space for caregivers in the ER, since in many cases the caregiver has accompanied the patient to the ER.
But in addition to the physical aspects of the ER, training of medical staff is a major consideration. UCSD and West Health are exploring the approach of staff including care processes and transitions.
“The first element is much more extensive screening in terms of cognitive decline,” Chan says. “We are missing opportunities to pick up on early cognitive decline.”
All nursing staff will be trained on this screening, as well as in care transitions. Post-discharge planning and communication is yet another prong of the research where opportunities lie, Chan says, of an acute care at home project aimed at reducing hospital readmissions.
“If we can get [patients] home or to assisted living, but we’re not able to make it to their home, there’s [some service we can provide] from the ED that may result in some significant costs saving,” he said.
That might include nurse visits within the first 72 hours post-discharge to perform IV antibiotic administration or blood draws. Encrypted text messaging incorporates the attending physician into the communication to document any care being administered. Nurses also record everything through the patient’s EHR. As construction gets under way, the researchers and partner institutions will learn more about what works in the senior ER, in hopes to help address a rising issue before it becomes a problem.
“Forty-two million [seniors] in 2030 will be seen in the ER,” Chan says, citing projections. “We don’t have the resources to manage that.”
Written by Elizabeth Ecker