Northwestern Memorial Hospital Becomes the First Level 1 Geriatric ED in Illinois

Level 1 is the highest tier of the American College of Emergency Physicians' Geriatric Emergency Department Accreditation program

An estimated 10,000 baby boomers turn 65 every day increasing the demand for geriatric health care. The nation’s emergency departments (EDs) are on the frontlines of providing care to an aging population with an estimated 20 million people 65 and older visiting EDs each year. Northwestern Memorial Hospital was among the first in the country to provide older patients with a dedicated geriatric ED and now it is the first hospital in Illinois to achieve Level One Geriatric Emergency Department Accreditation (GEDA), the highest tier of the new interdisciplinary geriatric standards set forth by the American College of Emergency Physicians (ACEP).

Geriatric EDs focus on optimal transitions from emergency care to other settings such as inpatient hospitalizations, home, rehabilitation, and long term care. The GEDA program, which ACEP launched in 2018, aims to improve and standardize emergency care for the nation’s older adults. Northwestern Memorial is one of only eight hospitals in the country to achieve Level One. The program promotes the goals of providing quality care for older adult patients, including enhanced staffing and education and geriatric-focused policies and protocols, such as transitions of care, quality improvement and outcomes and more efficient preparation of the treatment area.

“We’re proud to be the first Level 1 Geriatric Emergency Department in Illinois, an achievement that reflects Northwestern’s commitment to providing older patients with the comprehensive, high-quality care required to meet their unique health care needs,” says Scott Dresden, MD, medical director of Geriatric Emergency Department Innovations (GEDI) and emergency medicine physician at Northwestern Memorial Hospital. “Our geriatric ED focuses not only on the acute medical needs of older patients but we also consider other chronic conditions, psychosocial needs, and safety concerns that put them at increased risk for readmissions and hospitalizations.”

The voluntary accreditation includes three levels, similar to trauma designations, with specific criteria and goals for clinicians and administrators. Requirements begin with demonstrating that the participating ED (1) includes both a physician and nurse with specialized geriatric training on staff, (2) meets environmental criteria such as easy patient access to water and mobility aids, and (3) has a geriatric quality improvement program.

When a patient 65 or older presents at Northwestern Memorial’s ED, they are assessed by a nurse to determine if the patient would benefit from specialized geriatric care. Patients who qualify will have a one-on-one visit from a GEDI nurse who asks a series of questions to determine if the individual is experiencing mental or physical decline, if they are having trouble caring for themselves at home, and if they have medical complexities common in older adults.

The patient may also receive counseling from a social worker or meet with a pharmacist to learn about safely taking their medications. Older patients may also be placed in geriatric-friendly rooms with features including nonslip and nonglare floors, soundproofing, enhanced lighting and windows, and other elements designed to make older patients more comfortable.

“While the physical space can provide benefits to older patients, it’s really the GEDI team that provides a safety net for a vulnerable patient population that often needs care beyond the normal scope of an emergency department,” Dresden says. “When our GEDI nurses focus on transitional care, they can identify risks and safety concerns that can be addressed before we discharge the patient, decreasing their chance of readmission or unnecessary hospitalization.”

For an older patient, hospitalization comes with the increased risk of infection, falls, delirium, frailty, and death. Research shows that an estimated 60% of Medicare patients admitted to the hospital arrive through the ED. The goal of Northwestern Memorial’s geriatric ED is to reduce unnecessary hospitalizations of older patients and prevent readmissions.

“For an older adult, a hospitalization comes with serious risk and could lead to a loss of independence and decline in quality of life, as well as functional ability,” Dresden says. “Since starting this program in 2013, we’ve seen a decrease of unnecessary hospitalizations of older patients by 33%. When we discharge a patient, we can be confident that we are sending them home safely or providing them with the appropriate transitional care that they need.”

Northwestern Memorial is nationally recognized for its expertise in caring for older adults, ranking ninth in the country for geriatrics in the annual US News & World Report “Best Hospitals” rankings.

Source: Northwestern Medicine