Located in a separate area down the hall from the trauma bay, the new emergency department at SBH dedicated to geriatric patients accommodates four patient beds and includes such features as natural lighting, non-slip floors and a dedicated bathroom.
Many people age 65 and older suffer from chronic diseases and other physical and cognitive issues related to aging. Aside from the problems that send them to the ED, older adults may be at great risk of deteriorating while waiting for care. Many seniors sent to the ED are already suffering from delirium; others will develop it from both their medical conditions and from the way they are treated once they have arrived.
Dr. Joel Sender, director of geriatrics, believes the new geriatric emergency department will play a key role in supporting the needs of the community’s elderly population in a post-COVID-19 era.
“This will allow the patient to avoid the mayhem of a busy ED,” he says. This is especially important, he added, not just at St. Barnabas Hospital but in most urban hospitals, where a large majority of hospital admissions come through the emergency department.
“Medical and nursing staff improve recognition of geriatric problems before they get out of hand,” he says. “Coordination with inpatient care services will start more quickly and reduce opportunities for complications in the patient’s health.”
According to Dr. Daniel Murphy, chair, emergency medicine at SBH, “We believed it was important to open a separate physical space that will cater more to and be better for the care of older patients. Like our pediatric ED, it allows us to focus exclusively on a subset of patients with special needs. A trip to the emergency room can be a harrowing experience for any individual, but especially for an older, frailer and more vulnerable patient.”
Understanding the geriatric emergency patient and how their condition might present differently is important, says Dr. Murphy. “For example, while a younger patient having a heart attack might present with chest pain, an older person might come in with confusion or jaw pain. When an older person displays a change in mental status, or appears confused, that can be the sign of any one of a number of different acute problems. The presentation can be different in older people and needs to be managed appropriately by knowledgeable professionals.”
A grant to the hospital for the establishment of a geriatric emergency room was initially funded by The Fan Fox and Leslie R. Samuels Foundation Inc. from 2013 – 2015, but the construction of a dedicated unit was delayed by other pressing demands on the hospital. Although the new geriatric ED is opening several years later, the hospital credits the Foundation for helping it appreciate the need for this new space.
The geriatric ED opened several months after the creation of an inpatient ACE (Acute Care for the Elderly) unit on 3 South. The area consists of 12 beds that were previously used in hospice care.
“It’s all about creating a safe physical space that can adjust to the needs of these older patients,” says Dr. Sender. “It’s about teaching everyone to pay attention to several simple rules that respect the health and well-being of older patients. We know that for senior patients a hospital stay can be a great challenge – and, if not handled correctly, can lead to serious and preventable complications.”