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PROPER USE OF A GERIATRIC EMERGENCY
DEPARTMENT – SEEING THE RIGHT PEOPLE
As written above, a GED cannot be built in isolation, but
within a dovetailed system. Exit block from the GED must be
minimized, with priority given to transfer patients to alter-
native health care facilities when their social needs are the
primary problem. Similarly, the health care system needs
to better configure patient care outside of the hospital to
minimize transfers to the ED.
Electronic medical records will need to be shared across the
system. Medication databases are already helping providers
deal with patients who do not know or cannot tell us what
they take. Medication errors occur most frequently at the
time of transfer from one service to another, be it from the
ED to the ward or from a long term care facility to the ED
(8). Improved medical care needs to be provided in LTCs:
proper medication reviews to identify drug-drug interac-
tions and adverse effects could prevent many transfers and
admissions. Having a health care provider and Point of Care
testing available could further decrease transfers. Society
needs to be much more definitive about supportive care at
the end of life, eliminating futile ‘keep the patient alive at
all costs care.
Multi-disciplinary community clinics could become the
entry point for Primary Care Providers and families looking
for supportive care and evaluation of the elderly, rather
than the ED. Currently such patients are sent by ambulance
to the ED in most cities, at a point when the family cannot
cope any more. Having 7 day a week access to clinics in
the community would encourage earlier intervention and
planning; transportation to and from the facilities could
be by much less expensive methods than ambulances with
paramedics. Availability of such facilities would minimize
the frequency of a family leaving a parent in an ED out of
desperation and fatigue, for transport services would access
such facilities as the first destination.
Finally, the GED has to define clearly what its function is not.
It cannot become a holding unit for people waiting place-
ment to avoid admissions, admissions that often result in
months-long stays because of social (not medical) reasons. It
cannot become known as the sole entry point for multi-dis-
ciplinary care of the elderly. It cannot be built in isolation,
for the needs of the elderly far exceed any capability of what
a GED could provide – a system must be planned for and
built, with the GED managing the acute medical and social
emergencies. As our society ages, society must recreate
itself to accommodate this change. Expecting an ED to be
the solution for the needs of the elderly – a one size fits all
solution – may be convenient for planners but would ulti-
mately ensure worse overall care, not just for the elderly but
for all ED patients.
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