Rural and Remote Geriatric ED Care

Sara Kunkel

Rural areas share commonalities in both the way they deliver emergency care to older adults and the challenges they face, but rural emergency care providers and health systems are diverse. The need for quality improvement is great with 13.35 million older Americans living in rural regions. Representatives from rural EDs across the USA and Canada recently shared their observations and suggestions in a GEDC webinar.

Rural EDs experience advantages, such as having an intimate community where people know each other and where patients and providers may be more familiar with resources in their community. However, they continue to face staffing issues, recruitment and retention challenges, and the lack of care continuity. They are often limited in workforce availability and accessing the resources that are best for their older patients.
This group of rural healthcare leaders suggested a few strategies for improvement:

  • identify workforce pipelines and develop long-term strategies for “growing their own” emergency care clinicians to mitigate staffing issues.
  • build relationships with community services and local nursing homes and move upstream to address root causes of geriatric ED visits.
  • integrate the Age-Friendly Health Systems movement by using the 4Ms (What Matters Most, Medication, Mentation, Mobility), in every interaction with an older adult.

Kevin Wasko, MD, Chief of Emergency Medicine and Program Medical Director at North York General Hospital in Toronto, recommends incorporating universal ED assessment screenings and connecting patients to needed services while building trust within home health care and ED teams. Simple changes, easily accomplished even in a small ED, such as offering mobility aids and personal sound amplifiers can have a real impact on improving the health and well-being of older adults.
Tools and programs that EDs can implement include:

  • the Delirium Prevention Take Care Kit
  • the KINDER 1 Fall Risk Assessment Tool
  • a primary care notification program to ensure follow-up
  • the SCOUTS program, which sends healthcare technicians, like the Veterans Administration (VA), out to the home with the goal of addressing the root causes of the ED visit

These practices have proven to be effective interventions to improve the quality of geriatric ED care. They can help to improve the emergency department experience, can ensure continuity of care, and can prevent future need for emergency care. While all EDs, and certainly rural EDs, continue to face challenges in providing quality emergency care for older adults, ED leaders in rural locations used this webinar to offer tangible, practical steps toward improvement.

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