Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units.
Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined.
Corita Grudzen (corita.grudzen@nyumc.org) is an associate professor of emergency medicine and population health at NYU Langone Medical Center and Bellevue Hospital, both in New York City.
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Lynne D. Richardson is a professor of emergency medicine and of population health science and policy at the Icahn School of Medicine at Mount Sinai, in New York City.
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Kevin M. Baumlin is a professor of emergency medicine at the Icahn School of Medicine at Mount Sinai.
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Gary Winkel is a research professor of oncology at the Icahn School of Medicine at Mount Sinai.
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Carine Davila is a medical student at the Icahn School of Medicine at Mount Sinai.
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Kristen Ng is a medical student at the Icahn School of Medicine at Mount Sinai.
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Ula Hwang is an associate professor of emergency medicine and geriatrics at the Icahn School of Medicine at Mount Sinai.
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D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D017146:Models, Organizational; D009519:New York City; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D014218:Triage / Q000191:economics / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review
Elderly; Health Economics; Health Reform; Health Spending; Medicine/Clinical Issues