SENIOR-FRIENDLY E.R.
Sharp Grossmont Hospital reaches ‘gold standard’ status for efforts to improve care
Sharp Grossmont Hospital reaches “gold standard” status for its efforts to improve patient care.
During Vincent Quasarano’s March 30 visit to Sharp Grossmont Hospital’s emergency department in La Mesa, the experience may have been different than previous trips to the hospital. The 85-year-old patient was offered a voice amplifying device by registered nurse Michelle Christensen, then asked a series of questions to see if he could recall his name, the date and a series of words. She pointed to various objects in the room asking Quasarano what they were, accompanied him during a short walk down the hall, and inquired what his home life was like.
Christensen, assigned to the department as a geriatric emergency medicine or GEM specialist. found Quasarano to be cognitively aware and able to participate in the assessment. The test doesn’t always go as well for all patients.
“I had someone earlier this morning who didn’t even want to tell me her name, and who had some signs of dementia and things going on with that,” she said. “The biggest ones that we catch are the ones who are living at home, their family brings them in for a different reason, and all of a sudden they’re unable to follow directions.”
The new assessment is just one aspect of care that has evolved at Sharp Grossmont as it worked to achieve the gold standard, “Senior-Friendly Emergency Department” accreditation by the American College of Emergency Physicians (ACEP).
Along with the Gary and Mary West Senior Emergency Care Unit at UC San Diego, Sharp Grossmont is one of only two facilities in California and 14 in the country that have earned the gold standard status. There are also eight bronze standard facilities in San Diego County, but no local silver emergency departments, according to ACEP Geriatric’s data.
Sharp staff make senior-friendly updates
Caring for seniors in the emergency department at Sharp Grossmont has always been a priority for staff, but emergency physician Ashraf Kasto said administrators have worked diligently over the past two years to improve long-term health outcomes for the seniors who come through the emergency department.
A senior-focused section of the emergency department at Sharp Grossmont gives patients access to resources they might not otherwise have access to.
Kasto served as the physician champion for Sharp Grossmont during the accreditation process.
“(We’re) helping the older population in our community and giving them more access to health care through the emergency room without exposing them to potential risk of worsening medical issues that they have by being prolongedly admitted into the hospital,” Kasto said.
The rooms have been updated to be more private, with either doors or sounddampening curtains to remove distractions from the bustle and loudness of a typical emergency room, and art has been added to the rooms to put people at ease.
Walls in the seniorfriendly pod have also been painted yellow, one of the few colors older adults can see clearly, he said. Kasto said it helps patients feel more comfortable, improves their mood and provides a vibrant backdrop against the gray and white equipment in the room, which improves their depth perception.
Overall, the aim was to make the rooms feel less like a hospital and more like a hotel.
Aside from the physical alterations to make the emergency pod more seniorfriendly, the more impactful change has come in an assessment process for seniors who come in for treatment. Those visiting the department are now asked to complete a series of questions and tasks, as Quasarano was on March 30.
Some of those questions
“Most of our geriatric patients have specialized needs . ... We are seeing more memory care problems, and of course they have mobility problems, nutrition problems and things like that because the aging process takes away some of our independence.”
are to detect signs of dementia or delirium, while others are more functional, to determine if the person has a safe place to live, free of abuse, with someone who can act as either a live-in or occasional caregiver, depending on their needs.
Patients are then given an “identifying seniors at risk” or ISAR score and connected to resources based on their needs, said Julie Dye, clinical nurse specialist.
“They ask them questions about, you know, ‘Are you able to take care of yourself? Can you get food? Can you bathe yourself, dress yourself?,’ ” Dye said. “If they start answering no to these questions, it kicks off an automatic assessment by our geriatric emergency medicine nurse.”
In assessing everyone for signs of dementia or delirium, staff members are able to improve patient outcomes.
There’s also a dedicated, in-house pharmacist in the pod 24/7 who can look at the prescriptions that a patient is taking to see if the combination may have contributed to their visit to the hospital.
Pharmacist Aileen Chu has a desk in the heart of the emergency department, where she has face-to-face access to the medical team and patients.
“We get to directly interact with them, and perhaps even use that as an opportunity to identify knowledge deficits, opportunities for improvement to educate them,” Chu said.
“We use that opportunity to identify reasons why patients haven’t been taking certain medications that have, perhaps, caused them to be here in the hospital in the first place.”
Since implementing the changes to become more senior-friendly, Kasto said the department has seen a significant decrease in its return visit rate for patients 65 or older.
CEO Scott Evans said the effort was largely driven by the need to serve a growing demographic of seniors and older adults living in East County. Sharp Grossmont is also preparing to build a neurosciences hospital.
“Really, that absolutely ties to who would be using this hospital, mostly senior citizen community members,” Evans said.
“It’s sort of an extrapolation of the fact that we have become a comprehensive stroke center and are really focusing our efforts on developing that segment of our business toward that population.”
About 22 percent of the patients at Sharp Grossmont are 65 or older, with health care needs for older adults increasing and becoming more nuanced with aging, Dye said. In assessing patients within this demographic, they and their family caregivers can be connected to important programs such as respite care, meal delivery services and transportation to medical appointments.
“Most of our geriatric patients have specialized needs in adult medicine that’s different from the younger patient,” Christensen said. “We are seeing more memory care problems, and of course they have mobility problems, nutrition problems and things like that because the aging process takes away some of our independence.”
Some of the leaders of the certification effort at Sharp Grossmont, including Dye, were driven by the personal experiences they had caring for their own parents.
When her mother was injured and subsequently treated at Sharp Memorial Hospital a few years ago, Dye said figuring out steps for her mom’s at-home care after being discharged was difficult.
“It was so overwhelming to try to navigate the system, and I’m a nurse and had trouble navigating it,” Dye said. “(I was) trying to discover when will it be safe for me to go back to work and, like, what community resources could help me,
Left: An elderly patient is asked to write a brief sentence as part of his evaluation.
where I could have her at home and get to come back to work.”
She hopes the changes they made to the department will provide more comfort and relief to families like hers.
Nurse Michelle Christensen
Accreditation during a pandemic
The decision to upgrade the emergency department was made in the year before the COVID-19 pandemic began, and Sharp Grossmont reached bronze status in May 2020.
To continue making changes, the team had to balance closing rooms for updates while there was an increased need for health care as the novel coronavirus spread around the world.
“It was not just paint and dimmers; that’s a big undertaking with (the Office of Statewide Health Planning), getting sign-offs, and closing rooms during times when you have increased volume,” Larimore said. “We really just made the determination as a team that there’s value to this more than a certification, more than a title behind the ED’s name.”
Although continuing to make upgrades while simultaneously caring for those with COVID-19 was difficult, Evans and the team involved with the project all said the spread of novel coronavirus highlighted an increased need for specialized senior health care.
“We actually thought it was more important than ever,” Evans said. “Health care of course is about treating people, and I think that our specialized sort of approach to this senior population is more important in times where things are unpredictable for them.”