Clinical Champion Spotlight
This series highlights members of the GEDC community who are clinical champions for older adults in the emergency department. Aaron Malsch, RN, MSN, GCNS-BC is the Senior Services Program Manager at Advocate Health-Midwest (AAH) in Wisconsin & Illinois.
Malsch supports several geriatric models of care (NICHE, Geri ED, HELP, ACE Tracker, Geriatric Scholars). He leads the Geriatric ED implementation and has achieved ACEP Geri ED accreditation at 18 AAH EDs. Aaron contributes nationally to the improvement of care for older adults, highlighted by being former chair and current member of the geriatric committee at the Emergency Nurses Association (ENA), member of the international interprofessional team to update the Geriatric ED Guidelines, and reviewer of Geriatric ED Accreditation program at ACEP.
Before he attended nursing school, Aaron Malsch worked as a certified nursing assistant to determine whether or not the profession would be a fit for him. In this role, he was often asked to be a “sitter” overnight with patients who were experiencing “sundowning”, a phenomenon that is now understood as delirium.
During one shift, Malsch sat with a patient who demonstrated particularly violent behavior. For most of the night, she screamed at the top of her lungs and attempted to escape Malsch while he dodged her punches and insults. Malsch was successful in preventing her from harming herself, and she eventually fell asleep at 5 a.m.
“I was very happy to punch out at 7:30 a.m.,” Malsch said.
When Malsch clocked in for his next shift, his supervisor handed him a note from this difficult patient. The patient apologized for her behavior, thanked him for his help and invited him to visit her in the nursing home where she was discharged.
“The entire situation was very impactful – the stress of 10 hours of keeping her safe, recognizing the rapid onset and fluctuating course of her behavior, understanding a disease process changed her behavior, and her heartfelt appreciation of my work,” Malsch said. “This experience would come rushing back as I learned geriatric concepts such as delirium throughout nursing school and working as a nurse.”
Today, Malsch serves as Senior Services Program Manager for Advocate Health-Midwest, where he leads the system’s implementation and accreditation for the Geriatric Emergency Department Program in 25 emergency departments. He also contributes to research to improve the emergency department experience and outcomes for older adults.
One area of particular interest to Malsch is aligning value-based programs with the geriatric emergency department. According to Malsch, coordinating with downstream departments and the community can lead to improved patient transitions and help them to be successful upon their return to the community.
“A prime example is how we work with our rehab department for patients presenting with a fall to perform evaluations within the ED, but also provide seamless continuing care post discharge with outpatient PT balance and strength programs and evidenced-based programs such as Stepping On,” Malsch said.
Earlier this year, Malsch collaborated on a study of 10 Advocate Health-Midwest emergency departments that was published in the Journal of the American Geriatrics Society. The study demonstrated the success of a geriatric emergency department to order post-emergency department visit outpatient referrals for patients. The initiative reduced repeat emergency department visits, and patients who attended their outpatient appointments were less likely to be admitted to the hospital.
“The GED impacts outcomes beyond the ED itself,” Malsch said. “It keeps patients successful in the community and reduces ED and hospital overcrowding.”
Providing educational resources to equip emergency department nurses to care for older adult patients is another focus area for Malsch. He has studied the geriatric readiness of emergency department RNs and found they play a significant role that must be supported by an emergency department environment that maximizes clinical practice.
“Education is a foundational issue for the nursing profession,” Malsch said. “Regardless of if you are a novice or expert nurse, there are always professional growth opportunities to learn. Having a range of education resources appropriate to the experience level of the RN is essential. What a new graduate nurse needs versus a seasoned expert may be vastly different, but equally important for practicing at their highest potential.”
Throughout his nursing career, Malsch’s empathy for others has inspired him to pursue improved patient care and initiatives that yield better patient outcomes.
“As a nurse I have experienced both the immense highs and lows of outcomes for patients and their families,” Malsch said. “I feel it is a duty for us to improve those aspects in our control so that patients, families, and healthcare professionals’ negative experiences are minimized. In other words, ‘What would I want for my mother?’”
Aaron Malsch is the Senior Services Program Manager at AdvocateAuroraHealth (AAH) in Wisconsin & Illinois. He supports several geriatric models of care (NICHE, Geri ED, HELP, ACE Tracker, Geriatric Scholars). His focus is on nursing and interprofessional practice as it relates to the elder population throughout the AAH system of clinics, hospitals, emergency departments, home care services, and long term setting partners. In support of these models of care, Aaron has developed expertise in developing EHR workflow tools and reports to facilitate front line staff’s efforts and demonstrate outcomes. He leads the Geriatric ED implementation and achieved ACEP Geri ED accreditation at all AAH EDs. Aaron contributes nationally to the improvement of care for older adults, highlighted by being Chair of the geriatric committee at the Emergency Nurses Association (ENA), co-planner of GEDC symposium at the ENA conference, and reviewer of Geriatric ED Accreditation program at ACEP.