April 10, 2012

USA: For the Elderly, Emergency Rooms of Their Own

NEW YORK, NY / The New York Times / New York Region / April 10, 2012

A simulated skylight in the new geriatric emergency room at Mount Sinai Hospital is intended to help patients with end-of-the-day agitation and confusion. Yana Paskova for The New York Times
By Anemona Hartocollis

Phyllis Spielberger, a retired hat seller at Bendel’s, picked at a plastic dish of beets and corn as her husband, Jason, sat at the foot of her hospital bed, telling her to eat.

Although she had been rushed to Manhattan’s busy Mount Sinai Hospital by ambulance when her leg gave out, the atmosphere she encountered upon her arrival was eerily calm.
There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.
Ms. Spielberger, who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition. “It’s beautiful,” she said. “Everything here is wonderful.”
Yet this was an emergency room, one specifically designed for the elderly, part of a growing trend of hospitals’ trying to cater to the medical needs and sensibilities of aging baby boomers and their parents. Mount Sinai opened its geriatric emergency department, or geri-ed, two months ago, modeling it in part after one at St. Joseph’s Regional Medical Center in Paterson, N.J., which opened in 2009.
Holy Cross Hospital in Silver Spring, Md., opened one of the first geriatric emergency departments, which it calls a seniors emergency center, in 2008, and its parent organization, Trinity Health System, runs 12 nationwide, primarily in the Midwest, and plans to open six or seven more by June, a spokeswoman said.
Dr. Mark Rosenberg, chairman of emergency medicine at St. Joseph’s, said he had consulted on more than 50 geriatric emergency rooms to be opened across the country, from Princeton, N.J., to California, overcoming initial resistance from doctors and nurses who saw assignments to the units as scut work.
“They thought it was a bedpan unit, focused on nursing home patients,” Dr. Rosenberg said. “When they finally realized this was the unit that gave better health care to their parents and grandparents, they jumped onboard.”
Hospitals also have strong financial incentives to focus on the elderly. People over 65 account for 15 percent to 20 percent of emergency room visits, hospital officials say, and that number is expected to grow as the population ages.
Under the Affordable Care Act, the health insurance overhaul passed by Congress in 2010, hospitals’ Medicare payments will be tied to scores on patient satisfaction surveys and how frequently patients have to be readmitted to the hospital. (The Supreme Court is considering whether to overturn another section of the law, and if it does, whether it would have to throw out the entire law.)
Pertrilla Henry watching an iPad, which can be used
to communicate with nurses.
Yana Paskova/NYT
Even in their early stages, patient satisfaction ratings for Mount Sinai’s geri-ed are “off the scoreboard,” said Dr. Andy Jagoda, the hospital’s chairman of emergency medicine.
Patients who are picked up by ambulance can choose which hospital to go to, if circumstances and travel time allow.
At Mount Sinai, all arrivals go through triage in the regular emergency department and are sent to the geriatric department if they are over 65, know their name, were able to walk before the day of the hospital visit and are ranked 3, 4 or 5 on a standard emergency severity index of 1 to 5, with 1 being the sickest. Someone with a broken hip would probably qualify, but someone with an acute heart attack would most likely have to be stabilized in the regular emergency room first, said Dr. Kevin M. Baumlin, the vice chairman of emergency medicine, who founded the geriatric emergency room.
The geriatric E.R. — eight beds and six examining rooms — resembles a clinic more than it does an emergency room: there are nonskid floors, rails along the walls, reclining chairs for patients and thicker mattresses to reduce bedsores. To keep the noise down, the curtain rings and rods around the beds are made of plastic instead of metal.
“One of my pet peeves is the noise that curtains make,” Dr. Baumlin said. “You know, that metal clackety-clack sound.”   Continue reading...
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