New Geriatric Emergency Department Focuses On Care For Aging Population
Northwestern Memorial Hospital February 11, 2014
CHICAGO, IL – After a fall and subsequent trip to the emergency room, Gladys Nunley had her things packed, ready to be discharged from Northwestern Memorial Hospital. She wasn’t worried about the fall – the X-ray showed nothing was broken. However, the 90-year-old was concerned about what she would do when she got home to her Chicago apartment. Then she met Dwayne Dobscheutz.
Dobscheutz is a geriatric liaison nurse who represents a new Northwestern Medicine initiative that gives elderly patients an emergency room of their own. The initiative is two-fold. First, the hospital now offers special geriatric emergency rooms for patients 65 years old and older that are located in a quieter part of the hospital and feature natural lighting, televisions and non-slip floors. Second, the hospital now dispatches specially trained geriatric liaisons to older patients when needed. These geriatric liaisons are four nurses, including Dobscheutz, who have approximately 100 years of emergency experience. They have been trained in dementia, gate and mobility assessment and independent living.
The Center for Medicare and Medicaid Services (CMS) is funding the project at Northwestern Memorial, Mt. Sinai School of Medicine in New York City and St. Joseph's Regional Medical Center in Paterson, New Jersey. Since the program started at Northwestern Memorial in April, the four nurses have seen more than 800 patients in the geriatric emergency department. Only about 26 percent of those patients went on to be admitted to the hospital compared to 41 percent of non-geriatric patients, according to Amer Aldeen, MD, an emergency medicine physician who oversees the initiative.
“Our goal is to give better heath care to our parents and grandparents,” said Aldeen who is also an assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine. “We want to make sure the right patients get admitted to the hospital and those who are discharged get the help and services they need at home.”
Take Gladys for example. After just a few minutes Dobscheutz learned she lived alone, and that she needed to climb seven stairs to get to her front door. After asking Gladys to take a couple steps, Dobscheutz knew she might be able to take a cab home, but Gladys would never make it up those stairs without help. Gladys didn’t need to be in a hospital, but she wasn’t completely ready to return home either.
“I realized Gladys would not be able to get up the stairs to her home,” said Dobscheutz, who has been working in emergency departments for 20 years. “She was admitted to the hospital so she could rest and get a proper evaluation. In a short time, we were able to coordinate through the Department of Aging so she could get the physical therapy help at home she needed.”
Dobscheutz and his fellow geriatric liaisons take pride in their new titles, which are proudly displayed on their works badges. Around the hospital they’re called the “GEDI” nurses and Star Wars light saber icons pop up on a patient’s electronic record when they are consulting with an older patient.
The “GEDI” nurses are becoming more and more popular as doctors and emergency department staff hears about patients like Nunley and their other success stories. Those who work in hospitals are well aware of the term “gray tsunami,” a term that predicts the number of older Americans will almost double between 2005 and 2030 as baby boomers continue to age. Meanwhile, hospitals, physicians and nurses struggle on ways to prepare their facilities for the predicated drastic growth. Because one thing is almost certain: these older baby boomers will end up in hospitals and emergency rooms. AARP data shows that only 35 percent of people 65 or older think they will need long-term care in the future, while research shows that 69 percent of people who are 65 today will need some kind of support services at some point.
And it’s not just the clinical services these patents will need. They will also need a little extra compassion and understanding. Northwestern Memorial also started training volunteers who specialize in elderly patients. They visit rooms armed with reading glasses, Sudoku puzzles and magazines. According to Northwestern Memorial nurse and geriatric liaison Barbara Buckley many times elderly patients just want someone to talk to.
“We had one man who just wanted lunch,” Buckley said. “His wife was a patient, and they were waiting for her test results and both were a little anxious because every day she made her husband lunch. Her hospital stay disrupted their routine. Our volunteer saw his unfold and took the man to the cafeteria for lunch. It was a simple gesture but it made a world of difference.”
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