MDNews - Greater Boston

workers are on staff to assess and address patients' needs beyond their immediate medical situations and link them to com- munity resources. "The social worker in the emergency department in my opinion is a critical ele- ment," says Eric Csernyik, DO, Emergency Medicine Physician Program Director at University Hospitals. "There's a whole litany of things, and it is very time- consuming to go through all of these social needs in addition to taking care of whatever their medical needs may be that day." Caring Companions One component of the Good Samaritan Medical Center Senior ER in Lafayette, Colorado, is the availability of hospital volunteers as companions for patients who are alone. "We have the opportunity to pro- vide them with a caring companion, somebody who can come over and help them pass the time of day if they don't have a family member with them," says Judy Gorham, RN, MS, Director of Emergency and Trauma Services, Behavioral Health, and Nursing Resources at Good Samaritan, one of three SCL Health senior ERs in greater Denver. Targeted Training Continuing education and geriatric training are key to helping clinicians perform more thorough screenings for conditions such as depression, dementia and delirium for this patient population. For example, all of the geriatric ERs within University Hospitals and Saint Joseph Mercy Health System have staff who are Geriatric Emergency Nurse Education-certifi ed. "We've also developed training modules that are available for physicians …, and we have different topics that specifi cally relate to working with geriatric emergency medicine," Dr. Hess says. Challenges and Benefi ts Implementation of geriatric ERs does bring challenges in the form of funding, space allotment, environmental improvements and staff training. However, positive patient outcomes and decreased readmission rates justify the effort, hospital offi cials say. "What our goal was when we did this was to decrease the readmission rates, making sure [patients] had the pharmacy review and discharge planning," Gorham says. "We have seen a decrease as high as 10 percent in the patients who are readmit- ted in 48 hours." Despite an increase in the volume of patients 65 and older, Saint Joseph Mercy Health System has maintained 72-hour readmission rates of less than 1 percent since launching its geriatric ERs in 2010, notes Dr. Hess. "One of our goals is to … maintain [patients] in their own living environment, which is usually what is healthiest for them overall and gives them the highest quality of life," she says. "Our data is not yet conclusive, but our trends suggest that we're seeing or pointing toward a decreased admission rate." ■ R EI M AG I N I N G ER D ES I G N IN ADDITION TO providing for the unique medical and social needs of senior patients, geriatric emergency rooms enhance the patient experience through modifi cations to the physical environment. Amenities may include: + Grab bars and safety rails + Hearing aids and reading glasses + Large-print signage + Large wall clocks + Nonskid, non-glare fl ooring + Pressure-reducing mattresses + A quieter atmosphere + Reclining chairs + Softer, indirect lighting with dimmer switches "Walking from the acute side of the ED to the senior side, the noise level just dramati- cally drops and the pace slows down so that those patients themselves can understand things quite a bit better," says Judy Gorham, RN, MS, Director of Emergency and Trauma Services, Behavioral Health, and Nursing Resources at Good Samaritan Medical Center in Lafayette, Colorado. "In these physical changes, we wanted to improve patient safety, patient experience and patient satisfaction," adds Ann Hess, MD, an emergency department physician of the Saint Joseph Mercy Health System in Michigan. "But it is also our goal to improve the experience overall for their medical care." M D N E W S . CO M ■ MD NEWS Greater Boston | 1 3

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