COUNTY 1ST IN U.S. WITH ACCREDITED GERIATRIC ERS AT ALL HOSPITALS

New county elder-patient health officer will oversee service at 18 facilities

When San Diego resident Susan Nelson, 69, went to the geriatric emergency department at UC San Diego Health last year, she noticed some positive new accommodations that she hadn’t experienced during previous hospital visits.

“It’s like night and day between the regular ER and the geriatric,” she said.

As part of a pilot program in 2018, The Gary and Mary West Emergency Department at UC San Diego Health became the first local organization to receive accreditation as a geriatric emergency department, which means it supports seniors by providing a more comfortable setting and additional resources upon release.

Now, even more older adult patients will have access to care catered toward their needs. On Thursday, county officials announced that San Diego County has become the first county in the nation to have all 18 of its eligible hospitals receive the Geriatric Emergency Department (GED) Accreditation.

Prior to her stay in the UC San Diego Health GED last November, Nelson experienced health symptoms she said were unusual for her, including shortness of breath, fever, chills and trembling. A triage nurse at UC San Diego instructed her to dial 911 so she could be transported to the hospital by ambulance.

With a fever of 104.5 upon arrival, Nelson was admitted and treated for a bacterial infection. She spent the first night in the main emergency ward, before being transferred to the geriatric emergency department, which is specially designed and accredited to serve seniors.

Nelson’s second night during her stay was spent in a private, soundproof room with a comfortable bed and non-skid floors. The bathroom had higher toilet seats and a sink designed to minimize splashing, making it safer by preventing water from spilling on the floor.

Nurses checked on Nelson frequently, and after returning home, she received check-in calls to make sure she was continuing to heal well.

“They were extremely accommodating while I was there, and — even afterwards — so very caring,” Nelson said.

The news that all of San Diego’s

eligible hospitals are now GED accredited was announced Thursday during a news conference at UC San Diego Health, Jacobs Medical Center.

Nationally, there are 344 accredited GEDS through the American College of Emergency Physicians (ACEP), 56 of which are found in California.

San Diego County is home to a large population of people age 60 and older, and that demographic is projected to continue growing over the next decade.

Today, there are approximately 670,000 county residents in this age group, and by 2030, they are expected to surpass 900,000, said Nick Macchione, director of the county’s Health & Human Services Agency.

Seniors are more likely than almost any other age group to visit the emergency room. The county reports that each year, about 275,000 county seniors make ER visits, which leads to about onethird of all hospital admissions.

“That is why it’s critically important to have all our hospitals that are eligible be geriatric certified,” Macchione said.

Although specialized pediatric care for children has long been a mainstream part of the health care system, geriatric-specific care is relatively new.

The GED Accreditation program was established by ACEP in 2018 to help emergency departments better meet the health-care needs of seniors and improve their long-term health outcomes.

Receiving this accreditation means that a hospital has taken steps to become more senior-friendly by having staff trained as geriatric providers, which can include a Ged-specific medical director and nurse manager.

The program also calls for improvements to the physical spaces within the department, such as providing more comfortable furniture, non-slip fall mats, warmer blankets and hearing devices, Julie Dye said. She is a clinical nurse specialist at Sharp Grossmont Hospital, which earned its gold standard GED accreditation in 2021.

“When (seniors are) picked up, especially by paramedics, they’re encouraged to keep their hearing aids, glasses, things like that at home,” Dye said. “But then they get here and they have a lot of trouble seeing and hearing, and that makes the visit scary and confusing, and they have trouble with the plan of care.”

These departments also assess patients for dementia and other risks factors before being released, then offer support and resources to seniors after their stay to minimize subsequent hospitalizations.

The local effort to get all hospitals accredited follows years of collaboration between the county, West Health and the Hospital Association of San Diego and Imperial counties.

Having every hospital improve its care for seniors helps to build a better support regional system overall, said Dimitrios Alexiou, president and CEO of the Hospital Association of San Diego & Imperial Counties.

That means that if an ambulance is diverted from one hospital to another, or if someone has a health scare far away from their primary hospital within the county, they will still be taken care of in a similar fashion.

“It starts to elevate the community standard that a senior patient can go to any of the hospitals in reach within the region, and they’re going to have similar resources and similar tools,” Alexiou said.

Having specialized geriatric care during emergency department visits, with follow-up care after a patient’s release, has shown to improve long-term health care outcomes for seniors, said Dr. Zia Agha, West Health’s chief medical officer and executive vice president

A 2022 study from the Beaumont Health System in Michigan found that assessment and intervention of patients age 65 and older from a geriatric specialist reduced their length of stay. The researchers found patients were more likely to be discharged instead of admitted to hospital (54 percent compared with 29 percent) and patients were also less likely to be readmitted to the hospital within 30 days (56.8 percent vs. 64 percent).

“For most patients, going to the hospital is a scary thing, and then being told that you’re going to be admitted to the hospital is even more scary,” Agha said. “We know that there are some patients who can easily be managed at home if the right resources are made available and their concerns are addressed.”

Senior-friendly emergency departments are also associated with reduced long-term medical costs for senior patients.

A 2021 study published in the Journal of the American Medical Association found that for each Medicare beneficiary who received GED services, there was a mean health care cost savings of $2,436 to $2,905 within 30 days of their emergency visit.

Now that all local hospitals have received the GED accreditation, there are other steps the county is taking to better provide care for seniors and increase the number of practicing geriatricians in the region, Macchione said.

Hospitals that currently have the bronze or silver level of accreditation are encouraged to work toward earning the gold tier.

Macchione also announced Thursday that the county is in the process of hiring its inaugural chief geriatric health officer, which he said is a first for any county in the nation. Once this new health officer steps into the role, they will work with all departments within the county to address the needs of seniors, including at the county’s jails.

“That position is a real beacon position and will be the champion working with all the geriatric emergency departments,” Macchione said.