Abstract
The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.
Highlights
The emergency department (ED) setting can be an extremely challenging environment for vulnerable patients, especially those with advanced age, baseline cognitive impairment, functional limitations, or frailty
In this paper we will describe the creation of an Acute Care for Elderly (ACE) model in a Geriatric Emergency Department and how this model was implemented as part of the GEDI WISE intervention at The Mount Sinai Hospital
An admission to the hospital should be prevented whenever possible for this population to avoid the greater risk for adverse outcomes, such as delirium, iatrogenic infections, medication errors, adverse drug events, and functional decline, which in turn lead to more complex transitions to post-acute care, rehabilitation, or nursing home placement [6,21]
Summary
The emergency department (ED) setting can be an extremely challenging environment for vulnerable patients, especially those with advanced age, baseline cognitive impairment, functional limitations, or frailty. While the ED is the traditional entry point into the healthcare system providing essential acute emergency medical care, it is often not an ideal care environment for many older, vulnerable patients. The traditional model of ED care prioritizes efficient triage and treatment for an acute illness or trauma [4]. This model of rapid ED care does not afford time often required to identify and address the Geriatrics 2019, 4, 24; doi:10.3390/geriatrics4010024 www.mdpi.com/journal/geriatrics
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