Phoenix Is Home To The Only Accredited Geriatric Emergency Department In Arizona
More than half of Americans over the age of 65 have a chronic condition — think diabetes, cancer or Alzheimer’s disease. So imagine someone coming into an emergency department with multiple conditions. It happens. And the experience for both patient and provider can be challenging. But some emergency departments are changing the way they’re doing business.
It's a quiet Monday morning when a nurse at Banner University Medical Center in Phoenix gets a call from incoming paramedics.
"We’re coming in with a 65-year-old male. He's in a memory care area of a retirement home …"
Calls like that aren’t unusual here at Banner University Medical Center. Staff here see more than 1,000 patients a month who are 65 and older. Nationally, emergency departments (EDs) are treating seniors at higher rates than non-seniors, according to the American College of Emergency Physicians. But what makes this place different is that it’s the only accredited geriatric ED in the entire state.
"We know that older adults when they come into the ED, they have more complications," he said. "And there was a need for improving the care of these patients when they come to the emergency department."
Dr. Nimit Agarwal is the chief of geriatrics at Banner University Medical Center. Last November, Agarwal and his colleagues started the accreditation process with the Geriatric Emergency Department Accreditation Program.
"So we had to show that we were doing some initiatives," he said. "One of our biggest initiative in the ED is fall prevention in older adults."
But tackling something like falls, which is the leading cause of injury-related deaths among older adults, according to the Centers for Disease Control and Prevention, means taking an interdisciplinary approach.
"We have nurses who are specially trained for detection of falls. We have a pharmacist who looks at their medications," he said because polypharmacy is a problem in older adults. "We have the physicians who get training every month on what geriatrics-focused care could be."
So this probably sounds like what should be happening in every ED — but geriatric EDs and geriatricians themselves are in short supply.
"We have about 3,000 practicing geriatricians in the country," he said.
And that’s not enough. In Arizona, the shortage is already being felt. The Arizona Geriatrics Society says the state should have more than 500 geriatricians. But as of 2016, there were only 117. And the need is only going to grow as Baby Boomers age.
Julie Cobos is the nursing director for emergency department observation and trauma at Banner. She takes me on a tour of the geriatric ED. So, there’s not a separate ward for older patients, though that’s the goal. Rather there are six, age-friendly rooms. She points to a room with an age-friendly sign on the sliding glass door.
"That is my only age-friendly patient right now," she said. "It's a 68-year-old patient, and so the sign is on the door. It's been explained to the patient as to if there's any needs that may need to be met, we're here to attend to them."
Like providing extra pillows and blankets. Non-slip socks. Making sure their belongings are nearby so patients don’t scooch out bed. They also have easy access to food and drink.
But I ask Cobos: Can’t anyone who is in the ED get an extra pillow or chair?
"Yes, you can get pillows, non-slip socks, blankets all day long in every emergency department."
What’s different here is the level of care, the details. For example, what if a patients forgets their hearing aids?
"We have hearing devices. These things are fabulous. I've already had great feedback from our age-friendly community where this is assisted them in hearing what's being explained to them, tests that are being done, discharge instructions that are given that type of thing," said Cobos. "We have magnifier is in there if they're having problems seeing they forgot their glasses or what have you. Earplugs in case it gets too loud or noisy because it can get really crazy in here."
All of that is music to Phoenix Fire Capt. Benjamin Santillan’s ears. Santillan is a national certified dementia trainer. He says first responders are increasingly responding to calls involving people with Alzheimer’s disease. So Phoenix Fire is training its people to care for this population. But what happens when they arrive at the ED?
"Some of the common mistakes that are made by medical personnel is they get hands on the patients," said Capt. Santiallan. "They start touching them and they want to put the blood pressure cuff on, they want to put the pulse oximetry on, they want to take their temperatures and start changing them into a gown."
"And that can cause them to get more confused, more combative, and more restless," said. Dr. Agarwal.
It also helps to have staff trained in certain techniques like TADA.
"It's a mnemonic that stands for: tolerate, anticipate, do not agitate. So we train our nurses to follow the technique to calm the person down so that we don't have to use medicine or any physical restraint."
Something else they do: hire nurses who have experience working at assisted living facilities. Earlier, Cobos told me a story about one of her nurses and a 78-year-old patient with Alzheimer’s disease.
"Bless her heart. She was very scared. She was very confused, doing a lot of yelling in the room. The nurses kept trying to comfort her, so my charge nurse did a really cool thing."
Cobos is talking about nurse Brandi Cano.
"This little lady kept wandering everywhere, and she was pretty quick on her feet. We thought she was going to escape. So, I had her sit by me she ate lunch and ..." said Cano.
And she settled down. That small gesture changed everything and sometimes, that’s all it takes. Human connection.
There are about 100 hospitals across the country that are an accredited geriatric ED, but with an estimated 10,000 Baby Boomers turning 65 every single day, the numbers just don’t add up yet.