HCR -- Geriatric Emergency Departments

By John Ballard

I still don't like the dollars but the idea of this program is encouraging 

Analyzing a program called "Acute Care for Elders" (ACE) piloted in 200 hospitals across the country, the UCSF researchers found that ACE patients had a shorter length of stay of 6.7 days, versus 7.3 days for elderly patients in a traditional inpatient hospital setting.

The specially designed units also saved hospitals $974 per patient. Patients in the ACE units cost $9,477, compared to $10,451 for usual care.

With hospital prices pushing those of luxury vacation packages, I remain deeply skeptical about how medical bills are generated in America. (I cannot understand, for example, why a brief consultation with someone already in the system, no medical findings, sent home with words of sympathy and reassurance from doctor and staff, should cost more than a token amount. I would be shocked, first of all, if such an occurance happens with any regularity. And if it does, I would be further shocked if the visit were billed at anything that could be called a "token amount.")

But leaving that aside, having a designated unit and team to care for geriatric patients is obviously a good idea. Those of us who deal with the elderly daily know well that even under the best of circumstances they typically have specific needs not commonly seen in younger patients.. 

• Mobility (tripping and slipping hazards)


• Hydration and nutrition


• Hearing and vision issues


• Cognition, memory


• Impairments from past problems


• Equipment (walkers, canes, wheel chairs, oxygen)

Here are the links...

?More hospitals customize ERs for older patients

?For the Elderly, Emergency Rooms of Their Own (NY Times)

Phyllis Spielberger, a retired hat seller at Bendel�s, picked at a plastic dish of beets and corn as her husband, Jason, sat at the foot of her hospital bed, telling her to eat.

Although she had been rushed to Manhattan�s busy Mount Sinai Hospital by ambulance when her leg gave out, the atmosphere she encountered upon her arrival was eerily calm.

There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin�s-egg-blue sky, puffy clouds and leafy trees.

Ms. Spielberger, who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition. �It�s beautiful,� she said. �Everything here is wonderful.� Yet this was an emergency room, one specifically designed for the elderly, part of a growing trend of hospitals� trying to cater to the medical needs and sensibilities of aging baby boomers and their parents. Mount Sinai opened its geriatric emergency department, or geri-ed, two months ago, modeling it in part after one at St. Joseph�s Regional Medical Center in Paterson, N.J., which opened in 2009.

Holy Cross Hospital in Silver Spring, Md., opened one of the first geriatric emergency departments, which it calls a seniors emergency center, in 2008, and its parent organization, Trinity Health System, runs 12 nationwide, primarily in the Midwest, and plans to open six or seven more by June, a spokeswoman said.

Dr. Mark Rosenberg, chairman of emergency medicine at St. Joseph�s, said he had consulted on more than 50 geriatric emergency rooms to be opened across the country, from Princeton, N.J., to California, overcoming initial resistance from doctors and nurses who saw assignments to the units as scut work.

�They thought it was a bedpan unit, focused on nursing home patients,� Dr. Rosenberg said. �When they finally realized this was the unit that gave better health care to their parents and grandparents, they jumped onboard.�

Hospitals also have strong financial incentives to focus on the elderly. People over 65 account for 15 percent to 20 percent of emergency room visits, hospital officials say, and that number is expected to grow as the population ages.

Under the Affordable Care Act, the health insurance overhaul passed by Congress in 2010, hospitals� Medicare payments will be tied to scores on patient satisfaction surveys and how frequently patients have to be readmitted to the hospital. (The Supreme Court is considering whether to overturn another section of the law, and if it does, whether it would have to throw out the entire law.)

Even in their early stages, patient satisfaction ratings for Mount Sinai�s geri-ed are �off the scoreboard,� said Dr. Andy Jagoda, the hospital�s chairman of emergency medicine.

?Specialized Hospital Care for Elderly Patients Could Significantly Cut Costs

Landefeld and his colleagues say minor changes in the current health care model can yield significant results. Leaving patients in their hospital beds, for example, or constantly interrupting them in the middle of the night for disruptive evaluations, can lead to longer recovery time and longer hospital stays, he said.

�What do most elderly people want to do at the hospital? They want to go home, and they want to get there as soon as possible,� Landefeld said. �In the ACE program, families were involved from day one as opposed to being quarantined � from their loved ones. And we looked at restructuring how hospitals work to get more of the benefit without the unintended consequences.�