UNC Health Talk

Improving Geriatric Emergency Medicine

by Zach Read – zachary.read@unchealth.unc.edu

Studies show that the first visit to the Emergency Department (ED) by an older adult in the United States often marks the start of a downward health trend for that person, leading to return trips to the ED, hospital admissions, or death.

“Nationally, geriatric emergency medicine patients do not do as well as they should because the systems and EDs in place do not meet their needs,” said UNC emergency and geriatric medicine physician Kevin Biese. “For example, these patients often do not receive adequate care coordination after the ED visit or have critical access to home health. As a country, we can do so much better.”

Through participation in a $3-million national collaborative funded by The John A. Hartford Foundation and West Health, UNC Health Care is working to become part of the solution for this patient population by educating the wide range of health-care professionals involved in geriatric emergency medicine and generating new health-system initiatives to benefit these patients.

“It was a very productive meeting.”

In February, UNC Health Care held a geriatric emergency medicine boot camp to help achieve these goals. Nearly 100 UNC Health Care doctors, nurses, case managers, health-care administrators and others from system hospitals and facilities attended the event.

“It was a very productive meeting,” said Biese, co-principal investigator for the grant, which includes Mount Sinai Medical Center (New York), UC San Diego Health, Aurora Health Care, University of Pittsburgh Medical Center, Northwestern Health Care, Emory Health Care, St. Joseph’s Regional Medical Center, and the University of Chicago. “We harnessed one of our greatest assets as a health-care system – our compassionate and passionate caregivers and professionals – to brainstorm initiatives and share ideas about how we can connect these patients with the community resources they need in order to get well and be successful after their ED visit.”

During the boot camp’s morning session, professionals representing various areas of geriatric emergency medicine presented on topics that included overcoming the obstacles in care transitions for elderly ED patients; screening for hunger, abuse, delirium, and mobility in elderly ED patients; connecting elderly ED patients to Home Health; and aligning the grant’s goals with the mission of UNC Senior Alliance, the new accountable care organization (ACO) of UNC Health Care providers and independent community providers selected to participate in CMS’s Next Generation ACO value-based payment model.

“Looking across the room, I saw representatives from all entities – hospitals, ambulatory care services, and community services.”

“Looking across the room, I saw representatives from all entities – hospitals, ambulatory care services, and community services,” said Mark Gwynne, medical director for the UNC Senior Alliance. “As we talk about the need for more integrated care for elderly adults, this kind of representation and collaboration is critical in helping us get there. From many different voices across UNC Health Care, we heard about bright spots and success stories that will directly inform what we do moving forward.”

UNC emergency medicine physician Abhi Mehrotra echoed the importance of collaboration in bringing about the kind of integrated care that will improve the lives of elderly patients.

“We run into this all the time: there are patients we see for whom being sent home is not the right answer, but neither is admitting them to the hospital,” said Mehrotra, who serves as medical director of the Hillsborough Hospital ED and assistant medical director of the ED at UNC Hospitals in Chapel Hill. “So what is the solution for them to get them the care they need? It was exciting to see so many different people come together to focus on these solutions.”

During the boot camp, attendees also participated in “buffet-style” sessions – brief, informative, timed conversations about topics in geriatric emergency medicine, led by UNC Health Care experts. Attendees found topics on the agenda that interested them, dropped by the discussions, and moved on to another “buffet” when time was up.

The UNC boot camp impressed Tim Lash, chief strategy officer for West Health, which includes the Gary and Mary West Foundation.

“It was clear from participating in the UNC boot camp that the team at UNC is fully committed to the enhancement of emergency care for vulnerable older adults,” said Lash. “Through the Geriatric Emergency Department Collaborative, West Health, along with The John A. Hartford Foundation, looks forward to continuing our work with UNC to evolve acute-care models for our nation’s seniors.”

The boot camp welcomed leaders from the other health systems involved in the collaborative, co-principal investigator Ula Hwang, emergency medicine and geriatric and palliative medicine physician at Mount Sinai Medical Center in New York.

“UNC’s conference was unique because of the large leadership presence it had.”

“UNC’s conference was unique because of the large leadership presence it had,” said Hwang. “There’s a clear, demonstrated commitment from UNC to finding ways to improve care transitions and care coordination for older adults. As an outsider, I not only came to teach what I know and what we’ve learned at Mount Sinai, but also to learn from those who came to the meeting, and it was educational for me.”

UNC was selected as one of the nine original health-care systems in the collaborative because it has developed national guidelines for education and training in treatment of geriatric emergency medicine patients. By 2018, the collaborative hopes to expand to 50 health-care systems and to disseminate new ways of caring for elderly adults across all 5,000 EDs in the United States.