Senior-Specific ERs, Home Care Could Reduce Hospital Admissions

Hospital admissions have always been a major concern for the aging population, but the sheer numbers will make a rising problem even worse without alternatives to help take pressure away from hospitals.

With an influx of senior patients using emergency health care services, some health systems are exploring the ways in which they can improve the experience for seniors, specifically, and they’re also looking closely at care provided in the home before and after ER visits to help cut down on senior ER admissions and readmissions.

The University of California, San Diego, which operates multiple hospital campuses in greater San Diego, through grant funding of $12 million from San Diego-based West Health, is under way with plans to build a senior-specfic emergency room. It also has piloted a project to provide acute care at home. The care at home project is not restricted by age, but 90% of the patients are over age 65.

In the period of time 24 to 72 hours after a hospital admission, nurses provide care in the home such as blood draws, intravenous antibiotics administration and other medical services.

An additional layer involves encrypted text messaging between the nurse and the physician who assumes the care at home and can intervene if needed.

The Senior-Specific ER

The acute care at home project is one avenue UCSD is pursuing to improve the care process for seniors and all patients while taking some pressure away from emergency rooms. A senior-specific ER is also being designed with a similar goal in mind.  

The $14 million, 8,500-square-foot project anticipates completion in 2018.

Current emergency medical facilities do not have the capacity to serve the wave of senior patients that is coming via the “silver tsunami,” said Dr. Ted Chan, chair of the Department of Emergency Medicine at UC San Diego.

“When we look at the numbers in emergency medicine, there is one emergency department visit for every two folks over the age of 65,” he said on a panel last week during MedCity’s Engage conference in San Diego. “That’s over 500 visits per 1000 people over 65… As the population grows, we imagine that will grow. It’s a significant challenge.”

There are currently around 100 emergency rooms nationwide that market themselves as geriatric ERs, Chan said, although few are taking such a comprehensive approach as UCSD’s. The university is collaborating in its research with a couple of figureheads when it comes to geriatric ERs, including Northwestern Memorial Hospital in Chicago and Mt. Sinai Hospital in New York City.

The approach to developing a senior-specific ER involves both research and data analysis, said Dr. Zia Agha chief medical officer for West Health, on the same panel.

“On the research side we are doing research with UCSD and on a national level,” he says. “We are looking at data from three EHRs. One initiative is to create a data warehouse, allowing more rapid cycle research. [We’re] also looking at using data as an opportunity to create quality measures.”

Redesigning Emergency Care

In very loose terms, a geriatric ER is one that has specific accommodations for senior patients. This could mean materials used for flooring that can help prevent falls, for example. The UCSD project, which will break ground in 2017, is also looking at a number of other elements: ample windows for natural light; ambient light that will prevent patients from becoming disoriented; acoustics and sound absorption to help patients who are hard of hearing; considerations for mobility issues including fall prevention; and ample space for caregivers in the ER, since in many cases the caregiver accompanies the patient.

But in addition to the physical aspects of the ER, training of medical staff is a major consideration. UCSD and West Health are exploring the approach of staff, including care processes and transitions.

“The first element is much more extensive screening in terms of cognitive decline,” Chan says. “We are missing opportunities to pick up on early cognitive decline.”

All nursing staff will be trained on this screening, as well as in care transitions. Post-discharge planning and communication is yet another prong of the research where opportunities lie, Chan says of an acute care at home project aimed at reducing hospital readmissions.

“If we can get [patients] home or to assisted living, but we’re not able to make it to their home, there’s [some service we can provide] from the ED that may result in some significant costs saving,” he said.

That might include nurse visits within the first 72 hours post-discharge to perform IV antibiotic administration or blood draws as in the acute care at home program. And as construction gets under way, the researchers and partner institutions will learn more about what works in the senior ER, in hopes to help address a rising issue before it becomes a problem.

“Forty-two million [seniors] in 2030 will be seen in the ER,” Chan says, citing projections. “We don’t have the resources to manage that.”

Written by Elizabeth Ecker