A small but growing number of hospitals are building emergency departments

specifically for elderly patients at a time when the senior population is growing and
hospitals are incentivized to develop new ways to prevent re-admissions and improve
patient satisfaction.
That trend made the ECRI Institutes annual C-Suite Watch List of 10 clinical
developments, tools and technologies that raise questions about whether they improve
outcomes and are cost-effective. The list also includes catheter-based renal denervation
for treatment-resistance hypertension, real-time MRI adaptive radiation therapy, and
broader categories such as big data and intelligent pills, which are designed to
improve medication adherence and help prevent re-admissions.
On geriatric EDs, Robert Maliff, director of ECRIs applied solutions group at ECRI, a
Plymouth Meeting, Pa.-based not-for-profit research organization, asked, Is this money
being well spent? There are some instances where this might improve readmission rates.
(But) true robust data is not yet available for outcomes for senior-specific EDs.
More than 50 U.S. hospitals have opened EDs for elderly patients since 2011 and at least
150 more have senior-specific EDs in development, according to ECRI. But that doesnt
mean that senior-specific emergency departments are right for every hospital. Limited
data exist so far that show geriatric EDs save money for hospitals or patients.
St. Josephs Regional Medical Center in Paterson, N.J., in 2009 was one of the first U.S.
hospitals to open a geriatric emergency room. When the hospital built a new emergency
department in 2012, it allocated 24 of the 88 beds for elderly patients. About 12% of the
hospitals emergency department visits each year involve elderly patients.
Elderly patients account for up to a quarter of all ED visitors worldwide. They are more
likely to have complex comorbidities, require longer diagnostic workups, and be
readmitted. They often end up in the emergency department after a fall or not taking
their medications correctly.
Physicians and hospital leaders hope that providing specialized care to the elderly can
reduce readmissions and improve patient satisfaction. Under the Patient Protection and
Affordable Care Act, hospitals are penalized financially for having higher readmission
rates for heart attack, heart failure and pneumonia patients.
Diane Robertson, director of ECRIs health technology assessment information service,
said ECRI sees an uptick in the planning of hospitals and systems to implement seniorspecific EDs. Some hospitals are building new geriatric-focused emergency departments
while others are carving out part of their existing ED for seniors.

The growth can be attributed to several factors, including the healthcare reform laws
rules on readmissions and patient satisfaction as well as the aging baby boomer
population and their anticipated increased use of emergency services.
The geriatric ED rooms at St. Josephs are soundproofed to be quieter, have thicker
mattresses to prevent bed sores and use flooring that does not have a glare, which can
lead to a fall. Patients on average see a doctor within 13 minutes of their arrival at the
hospital. ED nurses receive specialized training, and geriatric nurse practitioners and
nurse managers are part of the staff. Staff members call patients the first, third and
seventh days they are home after a visit to the ED. The hospital reported that its 30-day
post-emergency department return rate for senior patients with the same condition fell
from 20% in 2009 to 1% in 2010.
Dr. Shari Welch, a researcher at the Intermountain Institute for Health Care Delivery
Research in Salt Lake City who studies how to make EDs more efficient, said hospitals that
treat at least 50 elderly patients a day, or 18,000 a year, should consider building seniorspecific EDs.
But as more hospitals look at building specialized EDs for elderly patients, or allocating
space within an ED for these patients, questions remain about whether senior-specific EDs
improve outcomes. The costs associated with this kind of ED can range from $150,000 to
$3.2 million, depending on the number of beds; retrofitting and structural modifications;
and new processes, protocols and staffing.
Maliff said hospitals receive no immediate financial payback from a geriatric-focused ED
because theres no difference in reimbursement based on the type of ED. Its those
outcomes which will really drive whether this financially and clinically makes sense, he
said.

Source:
http://practicemax.com/
http://practicemax.com/markets-we-serve/senior-living/
http://practicemax.com/markets-we-serve/regional-extension-centers/