Serving as lead strategic champion, Ula Hwang, MD, professor of Emergency Medicine at Yale School of Medicine, in collaboration with James Lai, MD, Pamela Martin, APRN, and Palleschi, PA from Geriatrics at Yale New Haven Hospital, was instrumental organizing and launching interdisciplinary, cross-departmental care protocols in delirium management and cognitive impairment assessments. These efforts led to Yale New Haven Health System (YNHHS) receiving the American College of Emergency Physicians (ACEP) elite Health System Geriatric Emergency Department accreditation designating eight of their facilities as senior friendly. The designation has only been awarded to 13 health systems nationwide.
“This was truly a team effort across all the YNHHS EDs, with many champions at each site collaborating to implement better care for our older patients,” said Hwang. The YNHHS hospitals that received the GED accreditation include Bridgeport (Milford and Bridgeport campuses), Greenwich, Lawrence + Memorial, Yale New Haven (York Street and Saint Raphael campuses) and Westerly hospitals as well as the Emergency Departments at Pequot Health Center in Groton and Shoreline Medical Center in Guilford.
Each year in the United States, adults aged 50 years and older make more than 40 million visits to an Emergency Department. “We know that older people seeking care in the Emergency Department have unique needs to address symptoms and requirements that are specific to their age group,” said Hwang. “Through this accreditation process our providers are trained to look for signs and symptoms of syndromes and illness in the elderly that could be potentially life threatening if left untreated.”
Specifically, clinicians in the Emergency Department have begun to use the “Confusion Assessment Method” (CAM) screening tool for delirium, an acute change in cognitive function and mental status resulting in confused thinking and reduced awareness of surroundings that increases risk of poorer outcomes, including death. According to ACEP, delirium is a presenting condition for up to 30 percent of older adults in the Emergency Department. Recognizing the signs early results in better treatment.
This was truly a team effort across all the YNHHS EDs, with many champions at each site collaborating to implement better care for our older patients.
Ula Hwang, MD
“This special level of accreditation recognizes systems that are positioned as senior-friendly and have adopted geriatric best practices towards providing top-notch care for older adults across their health system,” ACEP stated in its announcement to the hospitals. ACEP, along with support from The Gary and Mary West Health Institute and John A. Hartford Foundation, launched the Geriatric Emergency Department Accreditation (GEDA) program to recognize those emergency departments that provide excellent care for older adults.
The voluntary GEDA program, which includes three levels similar to trauma center designations, provides specific criteria and goals for emergency clinicians and administrators to target. The accreditation process provides more than two dozen best practices for geriatric care and the level of GEDA accreditation achieved depends upon how many of these best practices an emergency department is able to meet.