Staffing a senior-friendly ED means, in fact, building an interdisciplinary team.
The guidelines state
“The geriatric ED Staff and administration provides a multi-disciplinary team of care providers focused on the varying needs of the geriatric population.”
The objectives in staffing for a senior-friendly ED are twofold: (1) Optimizing ED visits, delivering and coordinating effective care for high-risk patients; and (2) avoiding unnecessary admission by increasing community services or alternate care (ex: convalescence home, rehab).
In a Senior-Friendly team you need these care providers:
- Geriatric Emergency Department Medical Director (Physician Champion)
- GEM nurse (Nurse Champion)
- Medical and nurses staff who participated in geriatric specific education
- Geriatricians as an inpatient and outpatient service
- Social workers
- Occupational Therapist
- Physical Therapists
- Community services coordinator
The medical director and the GEM nurse are usually the core of this interdisciplinary team. They support each other in implementing new tools, protocols, educational material, etc.
The role of the GEM nurse is about 50% clinical and 50% development and include the following (non-exhaustive list) responsibilities:
- Case management (clinical work)
- Maintenance of geriatric performance and program improvement
- Liaison with outpatient care and community services
- Development of educational material and protocol
- Member of selected hospital-based ED committees
In order to recruit a GEM nurse, a background in geriatric work or a specific certification is required. In every country or province, the requirement and training are different. For example, there is a training program in the United States called NICHE.
Outpatient Geriatric Services
When you start to build a Senior-Friendly ED, it is acceptable to not have all the geriatric services in place. (As was the case for Mount Sinai Hospital, where I work). But in order to establish an efficient system that will avoid more admissions and re-admission, a geriatric outpatient service has to be available as an alternative way to address our patients issues. Specific clinics have demonstrated their utility in reducing ED readmission. For example:
- Geriatric assessment clinic
- Falls prevention clinic
- Geriatric day hospital
Allied Healthcare Providers
In many EDs, a social worker is readily available. This social worker is a precious ally in organizing care in the community. She has knowledge about all resources accessible and key persons to contact. A community care coordinator based in the ED is a worthy ally because she can help coordinate emergent services for patients in order to get them home as soon as possible.
A physical therapist and an occupational therapist are very valuable in the ED. They provide assessment about the mobility of a patient, education about walker use for example, and most importantly they can recommend or not if this patient would qualify for a rehab program. They are usually not based in the ED but are readily available when their help is needed.
A pharmacist can help for medication reconciliation – an issue that is common among older patients.
In summary, an interdisciplinary team is the key word for a Senior-Friendly ED. Even if some of our roles and responsibilities overlap, we talk to each other, we help each other, we work in team for the greater good of our older patients.