The Missouri Baptist Medical Center emergency department has earned a Level 3 accreditation for geriatric care from the American College of Emergency Physicians (ACEP). MoBap is one of only three hospitals in the state with this accreditation and one of only 39 accredited nationally so far.
“Congratulations to the Missouri Baptist emergency department on achieving this major milestone. This team is truly a collaborative, compassionate group, of which I’m so proud to be a part,” says Pat Robertson, Missouri Baptist emergency services director.
ACEP launched the Geriatric Emergency Department Accreditation (GEDA) program to recognize emergency departments that provide excellent care for older adults as the U.S. population ages.
In 2014, ACEP, working with the Society for Academic Emergency Medicine, the Emergency Nurses Association and the American Geriatrics Society, developed and released geriatric ED guidelines ranging from adding geriatric-friendly equipment and specialized staff to providing routine screening for delirium, dementia and fall risk. Washington University emergency medicine professor Christopher Carpenter, MD, wrote these guidelines and serves on the ACEP Geriatric ED Accreditation Board of Governors.
Missouri Baptist Medical Center emergency medicine associate chief Joseph Galkowski, DO, says the ED’s GEDA accreditation process was “a long journey that began three years ago when we evaluated our patient population and asked, ‘Are we serving them in the most effective way?’
“The accreditation is a nice validation that what we’re doing is right,” Dr. Galkowski says. “But that’s not why we began this process. We were simply trying to do what’s best for our patients.”
In evaluating the patient population, the team found that 37 percent of Missouri Baptist Medical Center emergency department patients were older than 65, with falls often listed as the cause of their visits. Analysis of six months of data on patients over age 65 revealed that the ED had seen 989 patients over 65 for fall-related injuries and that 628 of those patients had been sent home. Without intervention for underlying weakness or environmental factors, they remain at risk for falling again.
The multidisciplinary project team focused on preventing falls among the elderly.
In response to the findings, the Missouri Baptist Medical Center ED created a multidisciplinary project team including pharmacy, therapy, case management, BJC Home Health, EMS resources, ED staff, Washington University Emergency Care Research Core fall experts, and both ED physicians and primary care providers.
Much research and brainstorming led the team to create a care path calling for higher-risk ED fall patients over age 65 to have a follow-up home health visit immediately after discharge.
The visit encourages patients to focus on eliminating the root cause of their fall. Also, when appropriate, the ED provides seniors with mobility assist devices such as canes or walkers.
The care path also includes ongoing communication with the patient’s primary care physician to ensure the patient has timely assistance in developing a long- term strategy to reduce fall potential.
In addition to the fall prevention program, MoBap is nearing completion of a two-year, $1.3 million capital improvement project to refresh the ED environment, focusing on safety for the geriatric population.
A key element of the plan is covering all floors with a non-slip material that’s easier to clean and reduces the risk of falling. All the rooms have been painted to visually delineate the corners, making it easier for seniors to spatially orient themselves. Dimmable lighting reduces eye strain and makes patients comfortable. Computers are positioned in the rooms to allow staff and physicians to look at the patient while charting. Large-face analog clocks in every room assist patients who may have vision impairments. Standard stretcher mattresses have also been replaced with a pressure- reduction type to reduce skin breakdown. And, in the future, ED facility enhancements will consider how MoBap may best serve this significant patient population.
As this work progressed, the team saw an opportunity to apply for GEDA accreditation, which was granted in January. To learn more about the accreditation process, go to https://www.acep.org/geda/.
“The GEDA accreditation validates all of the hard work by those involved in developing our fall program and in updating our facilities,” Dr. Galkowski says. “And we will continue to look for best practices and other ways to enhance the care we provide to all those in need, particularly our geriatric patients.”