The Wexner Medical Center’s Geriatric Emergency Department, which focuses on the care of older patients, is the first in the Midwest to achieve Level 1 accreditation — the gold standard for geriatric emergency care — by the American College of Emergency Physicians.
The ACEM launched the geriatric ED accreditation program this year to recognize EDs that are providing excellent care for older patients.
“This accreditation signals to the public that our institution is focused on the highest standards of care for our communities’ older adults,” said Dr. Mark Angelos, chairman of emergency medicine at the Ohio State College of Medicine.
The program is set up to have a more holistic approach to older patient care, focusing on issues at hand and improvements to be made, said Dr. Lauren Southerland, director of geriatric emergency care at the medical center.
“Assume you or one of your friends comes to the ER for a broken arm or a sore throat,” Southerland said. “Our goal is to get you either admitted or in and out of the hospital fairly quickly … The national goal is under four hours, and the ER is really well set up to do that for healthy people.”
Southerland said this rapid approach is a problem for older patients, however, because there can be other issues.
“If they have belly pain, it could be an appendix problem,” said Southerland, who led the application and accreditation process. “It could be an ulcer. It could be all sorts of things. And they often come into the ED with more difficult symptoms … so they need a lot more testing and a lot more time to sort things out. They’re also at higher risk for more problems.”
Any emergency department can achieve Level 3 status, Southerland said. Level 3 maintains the idea that all emergency departments with this standard have room for improvement when it comes to geriatric care. Level 2 and Level 1 indicate how much of that extra access to care equipment, education and training an ED has, she said.
The medical center, as evidenced by its Level 1 status, is providing its staff with more education on how older patients differ from younger, healthier patients and what can be done to provide older patients with the best care possible.
“The accreditation is just like getting an A-plus on a paper,” Southerland said. “The A-plus doesn’t matter. It’s the process that matters. So, changing our ED to get to this point, that’s what’s really been the important part.”
The emergency department added resources, such as staff education, walkers and canes for patients and collaborated with other emergency teams to attain its accreditation.
“Specifically, we are doing things to reduce delirium, and we can offer multidisciplinary geriatric assessments in the emergency department,” Southerland said.
Southerland said these assessments include access to pharmacists for medication review, case managers for extra help, physical therapists and geriatricians.
She also said staff members need to talk about what resources the patients have at home and what help they would have if an accident occurs, so that a team can be put together to meet those needs. She said that people who are older than 65 who go to the ER and are discharged have a 20 to 30 percent chance of having to go back in the following three months.
“We think it’s because we’re missing these other things like medication interactions, risk for falls, mild dementia or mild cognitive impairment,” Southerland said. “By not addressing these other issues when we see them first, we’re missing an opportunity to really intervene.”
The medical center had to pick 20 out of 26 different areas of high quality care and protocol to meet Level 1 criteria. Southerland said the geriatric ED will have to reapply every three years to maintain Level 1 status.
The ACEM is also putting into place a system that will allow EDs to upload data such as how many patients are being cared for, she said.