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Mount Sinai experts help prepare Emergency Departments for older patients

Over 65 representatives from 28 hospital emergency departments from across Canada and the U.S recently came together to learn about how to make their emergency facilities more senior friendly.  Hosted by the Schwartz/Reisman Emergency Medicine Institute (SREMI), a joint venture of Mount Sinai and North York General Hospitals, which organized the two-day Emergency Department Administration Conference in November, the course provided clinicians with a variety of evidence-based tools to address the specialized needs of an aging patient population.

“Emergency departments are, overall, very effective at treating a wide diversity of patients,” says Dr. Don Melady, an emergency physician at Mount Sinai Hospital and one of the creators of the course. “But older people have unique needs, including the potential presence of cognitive issues, multiple conditions and medications, complex social needs and support systems and other complications that require unique approaches to care.”

Mount Sinai, part of Sinai Health System, was the first acute care hospital in Canada to make geriatrics a priority in 2010. The hospital is widely recognized for leadership in providing integrated and specialized care for seniors across programs and clinics, including the Emergency Department.

Dr. Melady, one of the few emergency physicians in Canada focusing on Geriatric emergency medicine, notes that while great things are happening at many hospital sites across North America, few of these improvements are standardized or shared. The need to establish and share best practices in emergency medicine is a significant reason that Mount Sinai Hospital launched SREMI in 2013 as a first-of-its-kind initiative to propel research, education and policy development in the field.

“Participants at our course learned about implementing new policies, protocols and programs targeted to older people, as well as staffing issues, educational efforts, and considerations for end-of-life care,” says Dr. Melady.

The course introduced participants to innovative staffing models, including the addition of a nurse case manager focussed on older patients and strategies for assessing complex patients by a multi-disciplinary health-care team, including pharmacists and social workers. It also provided screening tools to identify older patients with cognitive impairments, like dementia and delirium, who are at risk of further decline and falls, as well as ideas for how to improve transitions of care between the emergency department and the community.  Offering emergency departments tools for providing optimal care of the elderly, including working with social workers and outside care providers, not only gives elders greater comfort for patients, but can reduce emergency department re-admission rates.

Dr. Melady is the only Canadian representative in a group of five academic physicians who received funding from U.S. foundations to examine strategies for senior-friendly care. This funding will allow the group to provide the same course to more hospitals and networks, and to study the intervention and its outcomes with the goal of making it self-sustaining. This is yet another example of Mount Sinai Hospital’s international leadership in the field, benefitting patients across North America.

“It’s in the best interest for everyone to get this right – patients, hospitals, the health care system,” says Dr. Melady. “We look forward to providing more such courses, so we can see what’s working best and how we can continue to improve.”