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All 18 private rooms in the emergency department in the Collier Boulevard campus were upgraded with amenities that better serve older patients, many of whom are frail and have a variety of impairments, said Christy De Leon, director of the emergency department.
Staff members involved in the project evaluated industry guidelines and recommendations. Geriatric-appropriate emergency rooms can be separate areas or integrated into the emergency room.
The American College of Emergency Physicians came out with guidelines in 2013 after spending two years working with other industry leaders in geriatric care.
Nationwide, 139 hospitals report their emergency departments are geriatric-appropriate, said Dr. Kevin Biese, of the American College of Emergency Physicians.
The national group began developing accreditation standards in 2016 for geriatric-appropriate emergency departments, and the accreditation standards were approved in 2017.
Nine hospitals are serving as pilot sites for accreditation, and 46 other hospitals have indicated they will be applying, he said.
“We expect to have a few hundred accredited by the end of 2019,” Biese said.
The national group does not advocate for hospitals to create a separate emergency room for older patients, he said.
Lee Health plans to add senior-friendly emergency rooms at its outpatient center at Cococut Point in Estero.
The expectation is hospitals will embrace geriatric-appropriate emergency rooms for a variety of reasons, but it often boils down to who is leading the cause at each hospital, he said.
A key element is providing nurses and physicians with education about the needs of older patients.
“It varies tremendously,” Biese said. “Some of it is ‘Let’s all pause and think a little differently about our frail older adults.’ ”
Sometimes, the expense of improvements is only nominal — for things such as light dimmers so patients can get rest and handrails to help prevent falls.
About 60 percent of patients admitted to hospitals after age 65 come through the emergency room, Biese said.
They come with unique needs and often have complex medical issues with heightened risk for falls, might have dementia and might lack a social network of support, he said.
Physicians Regional’s staff used the guidelines from the national emergency physicians group and recommendations from other organizations in deciding what changes to make.
Scott Lowe, chief executive officer of Physicians Regional Healthcare System, said the system is exploring all options to elevate the level of service, including considering accreditation for its geriatric emergency department.
Lowe said he is proud of the team at the Collier Boulevard campus for making the investment in becoming the only older-adult emergency department in Lee and Collier counties.
“Significant time was devoted to identifying the needs associated with emergency geriatric care, educating all of those involved and making the necessary renovations to the physical plant,” Lowe said. “We were pleased to make this investment for the advancement of care for the older adults in our community.”
A key element was in place at the start of the project — sliding glass doors in each of the 18 private rooms to drown out hallway noise.
“A lot of emergency departments only have curtains,” said De Leon, director of the department.
In each room, the privacy curtains in front of the sliding glass doors were changed out from a pattern to a solid color that has been shown to be more restful, especially for people with vision impairment.
People with impaired eyesight can get dizzy from looking at patterns on curtains, said Karen Hays, senior office coordinator for the emergency department.
Each room has a larger clock on the wall, the mattresses are thicker at 3 inches, and the call button device is larger, with bigger lettering so patients can hit the right button to call the nurses station.
The call button includes the ability to switch the television to closed captioning to display the audio portion as text for the hearing-impaired.
Seating for family members was upgraded to chairs with arms, to make it easier for older relatives to stand up. Four of the rooms are larger and have two reclining chairs.
But one amenity that might be the most memorable for older patients is a portable CD player and the offering of the greatest hits from the 1940s, with such notables as Bing Crosby, Billie Holiday and the Glenn Miller Orchestra.
“It is geared for patients with dementia; music of their era keeps them calmer,” De Leon said.
All staff in the emergency department were required to take a 10-hour class on care management for older patients, and the education is mandatory annually.
Every nurse, physician assistant and emergency room physician is required to complete the training, De Leon said.
Elderly patients are not waiting in the outer waiting room with crying babies or small children; they are brought back to a room for triage within 10 minutes of arrival, which is a pledge at the hospital, De Leon said.
In addition, Physicians Regional is meeting its pledge of emergency room patients being seen by a physician assistant or a doctor within 30 minutes of arrival.
Biese, of the national emergency physicians group, said music can be soothing; a hospital in Paterson, New Jersey, has a harpist in its emergency department.
Hospitals are exploring how to create a culture or a setting where the emergency department experience is friendlier, he said. Some examples include offering coffee and food to family members, and having volunteers on hand to answer questions, Biese said.
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