Providing Better Care
It is clear that some of these assessments lie outside the usual sphere of the Emerg physician’s activities.
However your next patient is a mildly cognitively impaired older person with six medications who lives alone — and now has a pelvic fracture. It’s Friday afternoon and your hospital has no available beds for admission.
- What are you going to do?
- What resources do you have in your Emergency Department to assess this patient?
- What are your options for discharge planning?
Remember that just as it takes a village to raise a child, it takes a team to care for an older ED patient.
Some Emergency Departments have developed an interdisciplinary team to support the assessment of this patient:
- a geriatric nurse,
- a specialized social worker,
- a direct link to home care,
- a means of accessing physiotherapy, a pharmacist, and occupational therapy,
- a protocol to hold the patient in the ED overnight to develop a more comprehensive plan for discharge. For an example of a Pre-Printed Order Record, click here.
It all takes time and people – but ultimately provides better care to the patient and better use of resources.
If you would like to review the various functions of this interdisciplinary team visit the Trauma and Falls section of this website – in particular review the section on Consulting the Team.
Discussion: Providing Better Care
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Team approach to GERi care
Unsafe ti dc
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Community paramedic is a good resource for this patient.
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fall
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great
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where is the money going to come from to support these extra resources? I fully agree that they are necessary but it seems as though this is the last thing that administration will do.
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reevaluate
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A holistic approach to care for the elderly
great information
work with the interdisciplinary team and family
good points
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okay
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good information.
It is good to have a team of resources.
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discharge planning is difficult at best sometimes, but bed availability is not always there.
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review was great
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great points
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support allows all workers to ensure proper assessment is completed
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point taken
great points
healthcare team is holistic care
probably would admit or observe them so full and complete assessments of functional and cognitive status can be performed.
important not to be pressured to discharge a patient just because on bed situation
A team approach to care of our geriatric patients is essential. Involving social work, physio, OT, etc is absolutely necessary.
It takes the village
Patients are often kept overnight to be assessed by these services (which are less easily accessed on weekends). A big problem we run into frequently is sundowning in these patients. Often the early signs of sundowning or delirium are overlooked and attention is drawn only when the patient becomes dangerously agitated (sometimes only after they have injured themselves or have gone AWOL). At this point there is a tendency to use physical restraints and poorly titrated anti-agitation meds (I often see lorazepam 1mg IV given) with many downstream ill effects. The plan for holding overnight must include a risk assessment for agitation, a plan for routine frequent monitoring in the at-risk patient, and a management plan for controlling agitation if it occurs.
Excellent points!
we frequently hold patients overnight. It is too difficult to make complete assessments of patients very late at night. Better to get people up and going in the daylight, with appropriate phone calls and information.
It’s the support system and home safety that is sometimes more challenging to manage
best care
safety first
prior to discharge review all the causes possible
la atención tiene que ser buena
Discharge is not easy. Need of a good and complete evaluation.
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better care
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Where do you find one of those geriatric nurses? Too often proper care of elderly not considered “glamorous” but complete care ensures better outcomes. It is not cost effective, or always tenable, to admit the elderly for the inpatient floor to deal with their non medical/surgical issues. This module presents a very nice approach to care.
It is essential to provide a complete service to patients in ER and to be sure not to discharge before arrangements needed are taking care of.
Agree with above, very unsafe to d/c. Hold over until bed is available or services in the home are set in place prior to patient leaving.
Comprehensive Geriatric assessment is very important. The patient from the case MAy need to go to geriatric rehabilitation unit for pain control, PT, OT assessment and safe discharge plan.( depends on PT/OT?SW assessment in ER)
as to the patient described above I think it very unsafe to discharge them, they should be held for observation, treated for pain and other conditions , contact family or other supports in am have geriatrics, nsg, sw, and ccac involved re ongoing care and discharge plans