Have you ever heard anyone say “I went to the emergency room and had a great experience?” I doubt it. In fact, quite the opposite is likely true. Most visits to the ER are endless waits, poor communication, and many ER's can best be described “like a war zone” said one physician assistant. The truth is, the national average wait time in an ER to initially be seen by medical personnel is 28 minutes , another 2 hours and 52 minutes until sent home, or, if being admitted, 5 hours and 34 minutes. Add 2 more hours and 16 minutes to actually get into your hospital bed. This is over ten hours! No wonder we all dread going to the emergency room.
Now imagine you are an elderly person; already ill enough to go to the ER. The environment is chaotic, noisy, beeping monitor's, loud voices, people crying, bright lights, and usually very cold. Now throw in a little dementia, and honestly, an ER can be a special kind of nightmare for the elderly and their family.
But did you know that a small but growing number of hospitals are building emergency room departments specifically for the elderly? Nine years ago, St. Joseph's Regional Medical Center in Paterson, N.J. was one of the first US hospitals to open a geriatric emergency room and now there are over 150 nationwide. Since elderly patients account for almost 25% of all emergency visits worldwide, it might just make sense to re-think how ER's meet their needs. Plus, researchers found that national visits to emergency rooms by the elderly have increased 34% in the last decade! Physicians and hospitals hope that by providing specialized care to the elderly, they can greatly reduce readmissions and improve patient outcomes. When Holy Cross Hospital in Silver Springs, Md. opened their Senior Emergency Center in 2012, their senior patient satisfaction scores were 95% positive.
We all know that people are living longer, the fastest growing population are those over 90, and baby boomers are turning 65 at the rate of 10,000 per day. This group is far more likely to have ongoing chronic conditions, complex co-morbidities, and require longer diagnostic workups. So what would a geriatric friendly ER look like?
Smaller designated area's away from the hustle and bustle of the main emergency department
Private rooms with simple layouts, soft lighting, non-glare /non-skid floors, with quiet music
Thicker mattresses to prevent bedsores which can start in as soon as 4-6 hours for the elderly
Being seen by medical personnel within 13-15 minutes
Specialized training for nurses as well as hiring geriatric nurse practitioners and geriatric physicians
Limiting unnecessary tests or procedures
Automatic cognitive screening at intake
Automatic review of patients total medications
Automatic follow up within 48 hours of discharge and continuing over the next two weeks
Social services setting up home nursing services immediately if needed
After doing a little research, I found out that if a hospital treats at least 50 elderly patients a day or 18,000 a year, they should consider building a senior-specific emergency department. I would be surprised if UF Health Shands Hospital and North Florida Regional Medical Center saw less that 50 elderly patients a day. I do know that Alachua County has a growing elderly population and more and more older people will be showing up in our emergency rooms. If hospital's want to stay competitive and are looking for ways to prevent readmissions (since they are now penalized financially for having higher readmission rates) , maybe now is the time to plan ahead for a geriatric friendly ER. I am hoping as our local hospitals continue to grow and add more and more specialty centers, they seriously consider building a senior friendly ER. There are many thousands of seniors and their families in this area that would benefit.