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'Seniors-only' ED draws raves from patients
Revamping existing space kept down costs
The senior emergency center at Holy Cross Hospital in Silver Spring, MD, may be a rarity, but based on the responses of patients and staff — not to mention our increasingly aging population — perhaps more EDs should consider creating a separate unit for older patients.
"Since we opened [in November 2008], we have averaged between 97% and 99% in patient satisfaction," reports Bonnie Mahon, RN, BSN, MSN, senior director of medical, surgical, and senior services.
David Cummings, RN, CEN, Holy Cross emergency center director, says, "Based on the patient responses, they are very appreciative of being placed outside the general ED population in a quiet area where the staff are more attuned to their specific needs."
The senior center is located within the ED itself. The space formerly was used for express care, which has been moved to another floor. The senior center has its own entrance and exit doors. All patients present in the main triage area of the ED. At that point, a set of criteria are used to determine if they should be placed in the senior center. First, they must be age 65 or older. Secondly, their placement is determined by the initial symptoms.
They use a scale of 1 to 5, Mahon explains. "If they are clutching their chest, for example, and are possibly having an MI, they are Category 1 and are immediately taken back to the acute side of the ED," she says. If MI, stroke, and acute bleeding are ruled out, which puts them in Categories 2 to 5, they are eligible for the senior emergency center.
Once the patients are placed in a room, the primary nurse conducts a six-question assessment. The assessment includes issues such as history of falls, the last time they were in an ED, and their current medications. "We want to see if they are at risk for return," Mahon explains.
If a patient responds positively to five or more questions, the nurse puts in a request for a pharmacy consult, Mahon says. "The pharmacist will review all the medications," she says. "We have had several 'saves' since we opened." For example, Mahon recalls a patient who came into the ED after falling. A review of the medications indicated the dosage level was too high, so adjustments were made. "We consider that a save," she says. A score of 2 or more triggers a visit from a social worker, Mahon adds.
Two weeks after discharge, a coordinator in the hospital's office of seniors conducts a follow-up survey. The survey asks patients how well the staff listened to them, if they were kept well informed, how they would rate the care and compassion with which they were treated, what they thought about noise levels, and if they would recommend the facility.