When older adults arrive at a hospital's emergency department (ED) , they may face unexpected challenges. For example, they may become less able to function independently. They may develop difficulties thinking and making decisions during or following a visit to the ED. This makes transitions in care to and from the ED an important area for improvement in our health care as we age.
To address these challenges, geriatrics experts have developed special programs such as the "Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements" (GEDI WISE) program. GEDI WISE is an award-winning program that serves as a model for excellence in emergency care for older adults in three large urban hospitals: Mount Sinai Medical Center in New York, NY; St. Joseph's Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL.
One piece of the GEDI WISE program includes an ED-based geriatrics transition care nurse (TCN). The TCN identifies patients who have health needs specific to older adults. This nurse works to help people transition to their homes so that they can avoid hospital admission whenever possible.
A team of researchers designed a study to learn how effective the GEDI WISE TCNs were for reducing hospital admissions, later admissions, and revisits to the ED. They published their findings in the Journal of the American Geriatrics Society.
The study took place in 2013-2015 in all three hospitals in the GEDI WISE program. They studied more than 57,000 people aged 65 or older who made more than 120,000 visits to the three participating hospitals' EDs.
The TCN nurses gave the older adults several different screenings, including tests for:
- Cognition
- Delirium
- Functional status
- Falls risk
- Caregiver strain
- Care transitions
Informed by these screenings, the TCN used various geriatrics resources to help patients. Some people required only a little support, while others needed extensive help.
Older adults who saw the TCN at least once during the study period were included in the "intervention group." Older adults who didn't see the TCN during the study period were included in the "control group."
Compared to the control group, people who saw the TCN had lower rates of inpatient (hospital or healthcare facility) admissions over 30 days at two of the three hospitals.
The researchers concluded that programs focusing on improving care transitions for older people seen in the ED may help reduce the risk for hospital admission.
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This summary is from "Geriatric Emergency Department (ED) Innovations: ED transitional care nurses & hospital utilization . It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Ula Hwang, MD, MPH; Scott M. Dresden, MD; Mark S. Rosenberg, DO, MBA; Melissa M. Garrido, PhD; George Loo, DrPh; Jeremy Sze, BS; Stephanie Gravenor, MBA; D. Mark Courtney, MD; Raymond Kang, MA; Carolyn Zhu, PhD; Carmen Vargas-Torres, MS; Corita R. Grudzen, MD, MSHS; Lynne D. Richardson, MD; and the GEDI WISE Investigators.
About the Health in Aging Foundation
This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.
About the Journal of the American Geriatrics Society
Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.
Journal
Journal of the American Geriatrics Society