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Enhanced A&E triage for elderly 'could reduce hospital admissions'

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Training accident and emergency nurses to identify elderly patients who need palliative or hospice care could help reduce stressful hospital admissions and improve quality of life.

That’s the conclusion of US healthcare professionals who are trialling a ground-breaking care model.

The new way of working, which has attracted interest in the UK, has been tested at Mount Sinai Hospital in New York as part of wider efforts to improve care for older patients coming into A&E.

It included training triage nurses to screen patients aged 65 and over to identify those at high risk of another imminent health crisis requiring hospital care.

“Identifying emergency patients who could benefit from palliative care interventions may both improve the quality of care and reduce costs”

Lynne Richardson

Emergency care nurses were also trained to identify high-risk patients who would benefit from palliative care at home or in a hospice and how to ensure swift referrals.

The changes were part of Mount Sinai’s Geriatric Emergency Department Innovations in Care Through Workforce Informatics and Structural Enhancements programme, known as GEDI WISE.

The screening was introduced in October 2012 and has been linked to a drop in the number of elderly patients admitted from A&E to the hospital’s intensive care unit.

Between January 2011 and May 2013 geriatric admissions to intensive care fell from 2.3% to 0.9% – equating to 535 fewer admissions and estimated savings of more than three million dollars, or more than two million pounds.

However, the Mount Sinai-based research team, who published their findings in the online journal Health Affairs could not say if the drop was definitely down to the GEDI WISE innovations, because other changes in geriatric care had also been introduced.

“This study shows that identifying emergency patients who could benefit from palliative care interventions may both improve the quality of care and reduce costs,” said Dr Lynne Richardson, who developed the GEDI WISE model.

“This could result in a better match of older adults’ goals of care with the environments to which they are discharged from the emergency department, including decreased admissions to the intensive care unit and increased referrals to hospice and palliative care provided at home.”

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Readers' comments (1)

  • It's a no brainer really ,Nursing Homes have been doing this job for years at considerably cheaper cost. Why are they not reconised more ,I wonder ?

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