An emergency department program focused on geriatric transitional care reduced the risk of unnecessary admissions of older patients at Northwestern Medicine by 33 percent.
The Geriatric Emergency Department Innovations (GEDI) program was introduced at Northwestern, Mount Sinai Medical Center and St. Joseph's Regional Medical Center, in fact, in 2013 and the hospitals reported Northwestern's results in a new study.
Since roughly one third of all patients age 65 and older visiting emergency departments are admitted, many hospitals can save on both costs and utilization by focusing on the older patient population. And if it's a readmission that occurs within 30 days of the original incident, hospitals are on the hook for financial penalties levied by the Centers for Medicare and Medicaid Services.
As for the patients, hospital admissions can increase their risk of delirium, infection and falls, the authors said. During and after hospitalization, many older adults experience a loss of independence and a decline in functional ability and quality of life.
In the study, nurses who were focused specifically on geriatric care determined if emergency department patients aged 65 and older were experiencing mental or physical decline, if they were having trouble caring for themselves at home and if they had medical complexities common in older adults.
Sometimes these patients would be moved out of the busy emergency department to a less active floor that had quieter rooms with doors, TVs and natural lighting that were more comfortable for them. The patients received follow-up calls after being discharged and were offered appointments with social workers, if necessary.
Patients visiting the emergency department who received specialized care were admitted to the hospital 36 percent of the time, whereas patients who did not receive the specialized care were admitted 53 percent of the time.
Northwestern's program staffs one or two GEDI nurses, one pharmacist and a social worker every weekday between 9 a.m. and 10 p.m. The nurses assess older patients who come into the emergency department to determine if they are candidates for the GEDI program. If a patient qualifies, he or she receives a one-on-one visit from the GEDI nurse to discuss everything from their medical state and if they've visited the emergency department in the last 30 days, to their support system at home.
The authors hope many other hospitals will see the benefit of creating a geriatric-specific program in their own space.