Mark Rosenberg, DO, will never forget the day he drove his tearful mother home from the emergency department, which had become a frequent destination after she developed renal failure and cardiovascular issues. Overwhelmed by long wait times, gang violence and overcrowding, she sought to escape the frenzied surroundings by signing herself out against doctor’s orders.
“Why don’t they make an emergency department for people like me?” she asked Dr. Rosenberg.
This idea motivated Dr. Rosenberg to establish a geriatric emergency department at St. Joseph’s Medical Regional Center in Paterson, New Jersey, where he serves as chairman of emergency medicine.
In this edited interview, Dr. Rosenberg discusses the growing role of geriatric emergency departments in patient care.
How did the project get started?
I consulted with my mom, aunt and their bridge friends about what they would want in an emergency department: a quiet place to feel safe with adjustable lighting and comfortable furniture. It took a few years of planning before opening an emergency department for patients 65 and older at my hospital.
What distinguishes the care provided in a geriatric emergency department from a regular emergency department?
The care we provide extends beyond emergency concerns. For example, imagine a scenario where a 75-year-old trips and hurts her ankle falling down the stairs. In a standard emergency room, a doctor will conduct a physical, take and evaluate X-rays, and give her medication.
In a geriatric emergency department, the patient will receive similar care plus be screened for geriatric conditions, including dementia, delirium, dietary problems, depression and risk for falls. Depending on the screening results, additional tests might be performed. For example, if the patient is at risk for falls, we will assess the home for potential fall risks, such as throw rugs or extension cords.
We conduct discharge planning to see if the patient needs a medical aide or someone to provide meals. We also make follow up calls one, three and seven days after discharge to check on the patient.
What are some of the emergency department features designed with seniors in mind?
Seniors have shorter wait times and are normally seen by a doctor within 13-14 minutes. We have a few extras to help patients enjoy their stay, including a kitchen area where they can make tea and a harpist who provides music therapy. It sounds like a spa but it’s actually an emergency department.
It costs the same to provide this level of care as a regular emergency department visit. The only difference is the coordination of care for the patient.
How has this model of patient care benefitted seniors?
Since opening the geriatric emergency department, the percentage of patients admitted has fallen almost 20%. We try not to admit seniors because they tend to feel better if they can recover at home. Our admit-to-home program enables low risk patients to take their medication and treatment at home. Then they come back to the emergency department for reassessment a few days later.