Targeting Seniors in the ER Can Bolster Partnerships, Reap Savings

Emergency departments could play a key role in care transitions for older patients and lead to overall Medicare savings, according to a study published in the Journal of the American Geriatrics Society.

More generally, focusing on seniors in the ED could also lead to better relationships between hospitals and skilled nursing facilities.

“The emergency department is that intersection of patients where it’s their last resort of care, whether it’s because of truly an emergency or because they don’t have access to care,” corresponding author Ula Hwang of the Icahn School of Medicine at Mount Sinai told Skilled Nursing News.


Even though more older patients with multiple medical issues are coming to the emergency room, hospitals should avoid the “knee-jerk reflex that everyone needs to be admitted,” she said.

The Geriatric Emergency Department Innovations (GEDI WISE) program was found to prevent unnecessary hospital admissions by as much as 33%, the study found. The analysis focused on 57,287 individuals with an Emergency Severity Index (ESI) of greater than 1.

Under the program, transitional care nurses would work alongside ED staff and go throughout the department to identify older adults that could be identified for discharge. The factors they examined included cognitive function, risk for falls and functional status, all of which are patient characteristics the ED team is not immediately focused on, Hwang said.


“Someone seen by a transitional care nurse had a lower risk, anywhere from 12 to 15 percent reduced risk, of hospital readmissions,” she explained.

Though the program was targeting patients that could be restored to a community setting, the ultimate goal of the program is to facilitate improving patient transitions to SNFs or sub-acute rehab, Hwang said.

Even though some patients who were seen by the transitional care nurse were admitted, they still benefited from the nurse’s presence in the ER. The transitional care nurse would start gathering the information needed for when a patient is discharged from the hospital, Hwang explained.

Collaboration Could Lead to Referrals

Information about patients is badly needed at transitions of care, and St. Mary Mercy Livonia of St. Joseph Mercy Health System, located in Livonia, Mich., saw this first-hand.

The senior-focused emergency room program got its start at the hospital in 2010, due to a projected 85% increase in the 65+ population between 2010 and 2040 in the region, according to Michelle Moccia, senior emergency room program director at St. Mary Mercy.

When a senior is admitted to the St. Mary Mercy senior ED, the department tries to get as much information as possible about the patient, including whether they live alone, whether they’ve gained or lost more than 10 pounds in the past three months, and whether there’s known cognitive impairment. This is not to grill the patient, but to determine whether they’re vulnerable, Moccia stressed. “It’s very purposeful, what we’re doing,” she said. “It has a meaning behind it.”

One of the questions asked is whether a senior has come from a skilled nursing facility, and if so, what that facility can do for a given patient. The hospital has a directory of all 34 facilities that surround it. It includes a description of the care each can provide.

“We really had to research what facilities are what and what their capabilities are, and that all came up from opening a senior ER,” Moccia told SNN.

The information-sharing goes even further, however. In 2011, Moccia sent an invitation to those 34 nearby facilities to come and partner with the hospital. Ever since, the facilities and the hospital have been meeting once a month to learn from each other.

“It was an eye-opener,” Moccia said. “I had no idea what each one of these facilities do. I had no idea which was independent and skilled.”

The hospital learned what each nearby facility could provide, and as a result of the meetings, the group was able to create a checklist to send in with a patient transfer form that provides information about the individual coming into the ER.

This information can include when a patient has last taken medications, the resident’s baseline mental state, and what their dietary needs might be.

“[The facilities] had no idea about all this. They didn’t understand how important it is for us to receive that information,” Moccia said.

Written by Maggie Flynn

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