An ER specifically built for older patients

Seniors spend a lot of time at hospital ER’s.  Now, a small but growing number of hospitals in the US have built ER’s especially for the aging patient – with wider hallways, motion detectors, hearing and visual aids.  To me, this is long overdue.

Older patients are avid consumers of emergency medical services.  Older people make up a significant percentage of the total population of ER patients.  A 2008 study found that every year, nearly 20% of all seniors use an ER at least once for medical care.  Another study published in 2010 found that seniors occupy half the stretchers bearing patients brought by paramedics to the ER.

Walk into most ER’s and you see a place that was clearly not built for older patients.  The hallways don’t accommodate walkers and wheelchairs.  The noise levels make it hard for patients to hear.  And there are seldom enough bathrooms for patients who need a little extra time.

Now, for the first time, a small but growing number of ER’s in the US have been built for older patients.  The ER at St. Joseph Mercy Hospital in Ann Arbor, Michigan has a new wing designated for older adults.

Handrails line each wall, and a nonskid floor resembling hardwood reduces the risk of falls.  Every bed has a thicker, pressure-reducing mattress.  As well, each bed can be set to sound an alarm if a patient prone to wandering gets up. Room lighting is softer, and the clocks are larger and thus easier for seniors to read.  Each room comes furnished with a walker; patients can also request reading glasses or hearing devices.

It’s not just the facility that’s different.  They’ve packed the place with health professionals who have a special interest and special training in geriatric medicine.  As well, physicians and nurses who work in the ER for seniors receive special education on issues related to ageism.  They’ve also taken seminars on sensory appreciation in the elderly.  The idea is to use these new-found skills to communicate more effectively with older adults and their caregivers.

As well, nurses have been trained not to be in a hurry when caring for older patients.  They take extra time with each patient to fully assess his or her condition.  They’re trained to do testing on a ‘routine’ basis that is done on an ‘as needed’ elsewhere.  For instance, nurses at St. Joseph Mercy Hospital do cognitive screening to help identify conditions that might have been missed in a traditional ER.

This is part of a wider trend across the US. St. Joseph Mercy’s parent company, Trinity Health System, plans to build Senior ER’s at nineteen other hospitals within the next few years.  Other hospitals have opened geriatric ER’s in Missouri, Texas, New Jersey, and Kansas.  Mount Sinai Medical Center in Manhattan plans to open one later this year.

In the US, the drive to build senior ER’s is motivated in part by hospitals’ desire to compete for older patients, the fastest growing segment of people in need of emergency care.  But there are good clinical reasons for a trend like this.  The hope is that they will help lower readmission rates and reduce the risk of drug interactions, both of which are common in seniors.  Another sound reason to build ER’s for seniors is to help prevent older people from losing their ability to live on their own.  Yet another is to put best practices for caring for seniors to good use.  For instance, regular ER’s frequently insert bladder catheters into seniors who can’t get to the bathroom fast enough.  ER’s that cater to older patients discourage that because catheters greatly increase the risk the senior will get an infection.

So far, the experience in Ann Arbor has been positive.  Since the ER opened in Ann Arbor last October, nurses there have spotted previously undiagnosed cases of depression, dementia and delirium.

From what I’ve seen, Canada is several years behind the US in developing special ER’s for seniors.  That doesn’t mean hospitals in Canada are ignoring the trend.  For instance, Ontario hospitals are hiring specialized G.E.M. nurses.  G.E.M. stands for Geriatric Emergency Management.  It’s a relatively new program that focuses on frail seniors in the ER.  Many all-purpose ER’s have social workers available throughout the day and evening to help arrange respite care in a nursing home.  As well, many ER’s hire a coordinator to help arrange for Home Care services to check to make certain the patient can safely go home.

In theory, it’s a good idea if you have the money to retrofit a general ER into one for seniors.  Frankly, I don’t see governments in most provinces coughing up the cash any time soon.

The one thing I have against geriatric ER’s is that they take all-purpose ER’s off the hook.  If you have an ER that caters to seniors, what’s the incentive for ER’s that treat people of all ages to do a better job caring for seniors?  Given the fact we don’t have the money to build ER’s for seniors, we need to teach people like me to do a better job.

What’s good medicine for seniors is undoubtedly good medicine for patients of all ages.

Adapted from a blog post that appeared on White Coat, Black Art.

Brian Goldman is an emergency physician and author of The Night Shift: Real Life In The Heart of The E.R., published by HarperCollins.

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