As many as one half of all hospital admissions begin in the emergency department (ED), and CDC data shows that visits by patients older than 65 increased by more than 25 percent between 2005 and 2015.1 The idea of specialty EDs emerged in recent years as a way to provide a higher level of care and reduce unnecessary admissions. Now a growing number of facilities are tackling ED volume by offering service-line specific care to serve the unique health needs of seniors and behavioral health (BH) patients.2
Geriatric ED accreditation
The American College of Emergency Physicians (ACEP) launched its geriatric ED accreditation program in 2018. The program offers three levels of accreditation, with the highest level requiring care enhancements that include:
— Staffing: an interdisciplinary group of physicians, nurse leaders, and administrators who set policy and protocol, including geriatric assessment and post-visit social work.
— Screening Protocols: at least 20 tools that identify health needs specific to older adults, such as screening for delirium, dementia, and fall risk.
— Environment and Equipment: a physically separate space for geriatric patients equipped with low beds, reclining arm chairs, PI-reducing mattresses, bedside commodes, and mobility aids. The enhancements also recommend enhanced lighting, non-slip floors, and noise reduction measures.3
More than 100 hospitals have established geriatric EDs or designated some of their existing ED space for older patients. ACEP reports a 3-4 month wait for EDs seeking accreditation.
Specialized care for BH patients
Hospitals are also noting a surge in ED patients with behavioral health needs, and some have converted entire departments or sections of the existing ED to create BH-safe areas.2 Similar to geriatric patients, the best care for BH patients may not include admitting them to the floor—but, rather, assessing and stabilizing their immediate needs and connecting them to resources outside of the hospital.
Enhancements often include ligature-resistant bed frames and support surfaces, while other supplies and equipment are removed from the room until needed. There is no current ED accreditation program for behavioral health, but The Joint Commission (TJC) emphasizes behavioral health in its National Patient Safety Goals® program to prevent errors and maintain patient safety. Under NPSG.15.01.01, hospitals must assess every patient’s suicide risk, as well as establish and maintain safe and suitable treatment areas for BH patients.4
1. 100+ hospitals have invested in geriatric EDs—featuring harp music, murals, and more. (2019, Apr. 26). Advisory Board. Accessed online: www.advisory.com/daily-briefing/2019/04/26/geriatric-ed
2. Kutscher, B. The rise of the specialty emergency department. (2015, Feb. 21). Modern Healthcare. Accessed online: www.modernhealthcare.com/article/20150221/MAGAZINE/302219980/the-rise-of-the-specialty-emergency-department
3. ACEP Geriatric ED Accreditation Criteria. (2019). American College of Emergency Physicians. Accessed online: www.acep.org/globalassets/sites/geda/documnets/geda-criteria-final_1.17.2019.pdf
4. 2019 National Patient Safety Goals. (2019). The Joint Commission. Accessed online: www.jointcommission.org/standards_information/npsgs.aspx
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Author: Teresa McKenney, BA, RN, CWCN