Emergency rooms adjusting missions to help elderly patients at home
CHICAGO — When 86-year-old Carol Wittwer took a taxi to the emergency room, she expected to be admitted to the hospital. She didn’t anticipate being asked if she cooks for herself. If she has friends in her high-rise. Or if she could spell lunch backward.
“H-C-N-U-L,” she said, ruling out a type of confusion called delirium for the geriatrics-trained nurse who was posing the questions in a special wing of Northwestern Memorial Hospital’s emergency department
Wittwer’s care is part of a new approach to older patients as U.S. emergency rooms adapt to serve the complex needs of a graying population. That means asking more questions, asking them earlier and, when possible, avoiding a hospital stay for many older patients.
The surprising truth? Hospitals can make older patients sicker. Infections, incontinence and weakening muscles from bed rest can cascade into delirium, frailty and death.
More than 30 percent of older adults go home from a hospital stay with a minor or major health problem they picked up at the hospital.
But for an emergency doctor, sending an elderly patient home sometimes feels risky.
“The doctors are not comfortable sending you home unless you’re safe,” said Northwestern Memorial’s Dwayne Dobschuetz, a nurse practitioner who started making house calls by bicycle a year ago for the health system’s geriatrics department. “It’s easier to admit older patients than to send them home.”
One of his patients, Marvin Shimp, 87, has lost much of his vision to macular degeneration, but lives independently. Dobschuetz helps him stay out of the hospital with regular visits to check vitals and answer questions.
“He becomes quite a helper,” Shimp said.
Emergency rooms have been called the hospital’s front door, so that’s where innovators are starting.
“The emergency department is not designed with older adults in mind,” said Dr. Scott Dresden, who heads the Geriatric Emergency Department Innovations program at Northwestern. “You’ve got really thin stretchers. You’ve got patients in the hallway. There’s mechanical noise all around.”
Early research at Northwestern and other hospitals shows care from geriatrics-trained nurses in the emergency room can reduce the chances of a hospital stay after a patient’s emergency visit and for a month afterward.
About 100 hospitals in the United States have opened geriatric emergency departments or trained ER teams in geriatrics care. These teams can arrange home services such as light housekeeping or a break for a caregiver.
The ideas are catching fire. Northwestern’s geriatrics ER has soundproofed rooms with comfortable beds and windows. Hospitals in New York, New Jersey, Pennsylvania, North Carolina, Wisconsin, Illinois and Georgia formed a collaborative to share ideas.
The latest nudge is an accreditation program, introduced this year.
“We want to have at least 50 certified hospitals by the end of 2018,” said Dr. Kevin Biese of University of North Carolina at Chapel Hill School of Medicine, who leads the accreditation push for the American College of Emergency Physicians.