Emergency department moves to age-friendly approach

Emergency department moves to age-friendly approach

UC Davis Health Healthy Aging Initiative continues momentum

(SACRAMENTO)

Older adults arrive at the emergency department (ED) with complicated needs that may not be addressed by standard triage protocols. They often present with cognitive impairment, multiple chronic conditions and pain that is difficult to assess. That’s why UC Davis Health is adding geriatric-specialty nurses and updating procedures in its ED as part of a systemwide focus on caring for seniors.

The ED at UC Davis Medical Center sees about 40 patients a day over 65 years of age, or roughly 14,500 patients each year.
The ED at UC Davis Medical Center sees about 40 patients a day over 65 years of age, or roughly 14,500 patients each year.

According to the Centers for Disease Control, older adults account for 15% of emergency department visits. The ED at UC Davis Medical Center sees about 40 patients a day over 65 years of age, or roughly 14,500 patients each year.

“Older adults present with complex medical and social issues, making them more challenging to diagnose and discharge,” said Katren Tyler, a UC Davis Health emergency physician whose research focuses on geriatric ED medicine. “With a continuing increase of people over the age of 65 in the ED, we must change how we approach these patients upon arrival, so that we can improve their experiences, streamline the discharge process and eliminate unnecessary hospitalizations.”

Increased expertise increases age-friendly approach

Tyler said 46% of older adults who come to the ED are admitted. Recently, UC Davis Health launched the Healthy Aging Initiative with the goal of delivering world class care to older adults. Developing age-friendly care within the ED is part of that vision. So, Tyler and her ED team are increasing their expertise – both human and technology – for the older adult population.

Olivia Oti, a registered nurse and the new Geriatric Emergency Nurse Initiative Expert (GENIE) nurse, is now on board to target geriatric assessment and streamline care.  UC Davis Health physicians and nurses still focus on the acute cause of an ED visit, but the GENIE nurse identifies patients with geriatric-specific health needs and pinpoints areas for intervention.

“My intention is to be an advocate and a champion in providing the optimum care in collaboration with the various disciplines in our facilities and outpatient resources for the geriatric population,” Oti said. 

In addition to Oti, two advanced practice providers with geriatric expertise serve in clinical rotations in the ED. Hannah Spero, an adult-gerontology primary care nurse practitioner (NP), and family nurse practitioner Victoria Jackson are both part of a new NP Residency Program at the Betty Irene Moore School of Nursing at UC Davis. Each brings geriatric expertise during their 10-week stints in the ED.

“We believe this collaboration between the ED Observation Unit and the NP residency program is a win-win for everyone involved,” said Debra Bakerjian, residency program director. “The NPs bring specialized knowledge and skill in geriatrics, while learning about why these patients end up in the ED and ways to strengthen outpatient care to prevent avoidable hospitalizations in the future.”

Screening advances improve detection


Katren Tyler

“In addition to increasing our human expertise in caring for older adults, we are enhancing our electronic health records (EHR) system to take into consideration the special needs of these individuals,” Tyler added.

EPIC, the EHR software used at UC Davis Health, will soon include the GENIE protocol. EPIC also now includes the new Identification of Seniors at Risk (ISAR) Screening.

ISAR is a 6-item screening tool that asks patients if they have been hospitalized in the past six months, identifies if they have trouble with their eyesight or memory and inquires if the level of assistance they need has changed.

Other age-friendly advances in the ED include:

  • Geriatric emergency management group to improve multidisciplinary care of older adult patients, including physical therapy, social work, case management, transitions of care, pharmacy, nursing and physicians
  • Geriatric cart in ED clinical areas to facilitate skin care, mobility and comfort
  • Mobility supplies to help older patients, including canes, quad canes and walkers
  • Geriatric pain panel and acute functional decline observation

“With these new tools, we can better detect seniors in the ED who are at increased risk for adverse outcomes,” Tyler added. “We believe it’s a great step toward achieving our goals of keeping people at the center of care and elevating the quality of care for older adults.”

One-year goals for Tyler and her team include earning a Level 1 Geriatric ED Accreditation from the American College of Emergency Physicians with support from a grant from the West Health Institute. All five University of California Health campuses hope to achieve a Level 1 accreditation. This would signal that UC Davis Health has essential geriatric-focused education and interdisciplinary staffing and provides appropriate transitions of care from the ED to other settings in order to achieve optimal geriatric emergency care.  

The Healthy Aging Initiative committees are also working to earn an Age-Friendly Health System designation. That designation is earned after proving that the health system follows an essential set of evidence-based practices, limits harm and aligns with what matters most to older adults and their family caregivers. ​