QUALITY: Seniors Get Special ER Unit at Maryland Hospital

Holy Cross Hospital, just outside Washington, has created a special emergency room section for older patients, complete with staff trained in geriatrics and communication, wooden handrails for safe walking, comfy chairs for family members, and extra thick ER mattresses designed to protect the fragile skin of the elderly against fast-developing bedsores.

Hospital CEO Kevin Sexton got the idea after, what else, a stressed out phone call from his elderly mom in a New Jersey emergency room. "It was the combination of her being there quite some time and it being very crowded and chaotic. It came to me we really do treat seniors poorly in that setting," he told the Washington Post. Developed with the assistance of outside experts on aging, there is apparently only one similar program in the country.

Elderly patients with traumatic injuries or acute crises (i.e. car crashes or heart attacks) will go into the regular ER, but most elderly patients seek emergency treatment because of pain, falls, or problems related to chronic conditions. They will be steered to the special seniors section.

The article focused on stress reduction and comforts, but the care model also has implications for better outcomes, even beyond those extra precautions about falls and bed sores (which can be very dangerous).

Once the patient is stable, nurses screen for cognitive loss, depression, possible interactions from taking multiple medications, and alcohol and drug use. They also perform a risk assessment for falls, neglect or abuse. Those who test positive in any of these areas are referred to community resources and receive a follow-up call from a geriatric nurse practitioner or social worker.

We've been doing some reporting recently on the high risk the elderly have on ending up back in the hospital after one ER trip so this screening, coordination and follow up may prevent or minimize that revolving door. That saves money, and it's much, much better for the patient. It will be interesting to see how this program evolves—anecdotally the patients and family members in the Post story were quite pleased— and whether other hospitals develop similar strategies for the aging population.