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Queens Chronicle

SENIOR LIVING GUIDE Jamaica Hospital MC ups its game in the ER

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Posted: Thursday, July 18, 2019 10:30 am

A healthier, longer-living population poses challenges to the medical field.

“Ten thousand baby boomers are turning 65 every day,” said Dr. Shi-Wen Lee, vice chairman of emergency medicine at Jamaica Hospital Medical Center in an interview last week.

The hospital wanted to be ready. And last month, JHMC was accredited as having a geriatric emergency department by the American College of Emergency Physicians, the only hospital in Queens with such a designation.

The hospital said in a related statement that while people living longer is their aim, it does require the healthcare industry to adapt to caring for a growing senior population.

Senior citizens utilize the hospital system at higher rates than nonseniors and they often require treatment for multiple chronic conditions. While seniors make contact with the healthcare system at many different points of care, the place where they most often receive their care is in the emergency department.

Lee said the hospital began the application process for certification more than six months ago — and that the ACEP’s standards are demanding.

“It’s about our process, our training for geriatric emergency care,” Lee said. “It’s not just about space and equipment. That’s the easy part — all you have to do is buy those.”

A statement issued by the hospital said the doctors and nursing staff had to meet many criteria, and both received extensive education and training in geriatric emergency medicine, training aimed at helping providers better understand and address the complex social and physical challenges of the geriatric patient.

In addition to receiving focused education, the hospital also needed to implement geriatric emergency care policies and guidelines, ensure geriatric patients received access to specific equipment and supplies, and even make accommodation the emergency department’s physical environment.

“This training is [intended] to help providers better understand and address the complex social and physical challenges of the geriatric patient,” the hospital said.

“The process to achieve this designation was not an easy one; it required hard work and dedication by many, but ultimately we feel that it displays a commitment to elevating the level of care we provide to our geriatric patients,” said Dr. Nathan Washburn, an ER attending physician integrally involved in the accreditation process, in the hospital’s statement.

According to its website, the ACEP was founded in 1968 by a small group of physicians who shared a commitment to improving the quality of emergency care. Its members set out to educate and train physicians in emergency medicine to provide quality emergency care in the nation’s hospitals.

And Lee said any hospital receiving the group’s specialized certification must be thorough in its application and performance.

“You have to make sure the same process is in place on both the day shift and the night shift,” Lee said. “You have to use the same process if I’m on duty or another doctor is.”

He offered the example of a patient coming into the emergency room with an ankle injury.

“If a person is younger, we’ll take an x-ray,” he said. “If the ankle is broken, we’ll set it. If it isn’t, we’ll wrap it and send them home.”

A senior citizen, he said, requires more specialized attention.

“We also want to know why that senior injured an ankle,” he said. “Does that person have dementia and walked out of the house at night when he thought it was daytime? Does the patient need a walker? Does that patient have balance issues? Are they taking medications that are interacting, maybe from multiple physicians?”

Not that the space and equipment aren’t important.

Lee said the emergency room has a separate section for geriatric patients, one that is quieter and can spare an elderly patient the noise and commotion of a drunk patient or a trauma case coming in through the ER doors. The section has things like walkers and a refrigerator with stores of food and water that a senior might need.

But he said it needs to go deeper still. They have doctors and nurses trained to spot signs of physical abuse; social workers to determine if a patient lacks resources for proper food and other material necessities or is isolated socially.

Then comes the emergency department’s role in caring for a patient who must be admitted.

“Eighteen percent of the patients who come into the emergency room are seniors,” Lee said. “But they make up 46 percent of the patients who are admitted. And 50 percent of those patients are admitted to critical care. Geriatric patients who are admitted are sicker patients.”

At this point, Lee said, they also are looking to work with a patient to discuss what they are looking for out of treatment. One example, he said, might be a senior who is seeking more mobility from the treatment he or she receives at JHMC.

“If we don’t put in the orders ‘bed to chair’ immediately, that person will be kept in bed,” Lee said. “Someone who is young can be in bed for two or three days with no problems. But older patients can become deconditoned very quickly.”

He said they would like to switch the current thinking by instead making an elderly patient as ambulatory as possible after admission unless the doctor’s orders are to keep them in bed.

“Reverse the process,” Lee said.

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