For the Elderly, a New Kind of ER

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Bringing Specialization to the Emergency Room

Dividing emergency departments into specialized treatment areas is not a new concept. There are "fast track" ERs for minor medical problems and pediatric emergency departments to care for kids.

As the population grows older, geriatric ERs may be the next natural step in improving emergency department efficiency. Many experts see this as important progress in identifying and accommodating the needs of the aging baby boomer population.

"It does shed more light on geriatric care, which is sometimes an overlooked part of the way we practice medicine," says Dr. Nafis Ahmed of the University of Pennsylvania.

The inspiration to create emergency treatment areas for the elderly comes from a large body of research that finds older patients have different patterns of emergency department use and thus different needs than their younger counterparts. As a while, this group incure a higher number of visits, more urgent visits, longer visits, more frequent return to the ER and higher rates of complications.

But will the specialized treatment areas solve these problems? Not all emergency physicians are so sure. They question if patients are having better outcomes as a result of these changes.

"People think 'I am in a specialty area, I must be getting better care.' But that is not necessarily true," said Dr. Alfred Sacchetti of Our Lady of Lourdes Medical Center Camden, N.J. He explains that this is just one way of making the emergency department visit more pleasant for a certain group of patients and that there are other ways to keep patients comfortable, happy, and healthy.

"Seeing them quickly, treating them quickly, and getting them admitted to the hospital or back to their own home also makes for a good -- maybe even better -- experience."

Sachetti said he sees geriatric emergency departments as perhaps best suited for hospitals that have the longest emergency department wait times. If you spend more time in the ER, you might find the services offered by the geriatric ER comforting. But if you will be in and out in an hour or two these features may have less of an impact.

Plus, he said, research has yet to show exactly what benefits, if any, these new units offer. "Here's the problem with specialty emergency departments, there's no data that you have any different outcome," Sacchetti said.

Many hospitals track return visits to the emergency department within 30 days of a visit as a measure of providing effective care. Mahon admits that so far Holy Cross has not seen an improvement in the number of return hospital visits that they hoped for, citing about a 1-2 percent reduction.

"We're not where we want to be yet," Mahon said.

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