For the Elderly, a New Kind of ER

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"It wasn't chaotic like I'm used to in past experiences in emergency rooms," says Denis J. Mulligan, 65, of his recent trip to the new Seniors Emergency Center at Holy Cross Hospital in Silver Spring, Md.

Monitors beeping, loud voices, and people scurrying about are just a few of the things people associate with a busy emergency department. Many people may consider these factors a nuisance, but for older patients, these are things that may be downright frightening and could even affect their health. A new trend in emergency department design is seeking to optimize the environment in which older patients are treated.

Referred to as "geriatric" or "senior" emergency departments, these facilities have been popping up across the country since the first one was opened at Holy Cross Hospital in Silver Spring, Md. in 2008. They are usually small areas, away from the hustle and bustle of the main emergency department. Private rooms, simple layouts, natural lighting, more volunteers, and soothing music are among the many features Holy Cross and other hospitals across the country are adding, all aimed at creating a calm and comforting environment.

Beyond making older patients more comfortable, the focus is really on keeping them safe. Dr. James Del Vecchio, medical director and pioneer in the creation of Holy Cross Hospital's senior emergency center, thinks their follow-up service is one of the most important safety features of the care provided. Social workers are instrumental in this process. They not only set up home nursing services, but they make follow-up calls to every patient within 48 hours of being seen.

"They are checking to make sure the patient was able to get all the prescriptions or doctor appointments that they needed," Del Vecchio said.

Managing medications is another area where these senior facilities hope to intervene. At the Holy Cross Hospital, any senior who comes in on five or more medications has their prescription list reviewed by a pharmacist before leaving. According to Bonnie Mahon, director of senior services, "We've had some real saves from this. One woman kept falling until our pharmacist realized that the dose of one of her medications might be causing this."

Bed sores, one of the most common complications of hospitalization, are associated with higher costs and longer hospital stays. Research shows that these wounds can occur in as little as 4-6 hours, suggesting they may be starting to form while the patient is still in the emergency department. But the Geriatric ERs are addressing that problem as well.

Instead of the traditional thin layer of foam covered in plastic, thicker mattresses, such as the four-inch Tempur-pedic ones at Holy Cross, are being used in hopes of reducing the occurrence of these wounds.

Del Vecchio also points out that every senior who comes through the door is asked 8 to 10 simple questions which help screen for problems that seniors are more prone to, ranging from memory impairment to risk for falls at home.

And to combat falls in the hospital, Holy Cross has modified the flooring and lighting. Mahon explains that some types of lights can create shiny spots on the floor. This interferes with depth perception and can lead to falls, especially in the elderly.

These changes in emergency care have been well received by the senior population. DelVecchio and Mahon say their patient satisfaction scores are over 95 percent positive.

Mulligan is once such satisfied patient. "Usually when I enter a hospital, even as a visitor, my anxiety triples. This was different, it did help relax me.

"I felt like an individual rather than just a chart or a number. They always told me what was going to happen, as well as when and why."

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