EMED Toolkit Spotlight: Louis Stokes Cleveland VA Medical Center

Heather Wojtarowicz

GEDC’s System Spotlight Series shares the great work that member organizations are doing in the field of geriatric emergency medicine.

Through the pursuit of GEDA accreditation, implementation of meaningful QI initiatives, and provision of educational resources for clinicians, health systems that take advantage of GEDC membership are setting the standard for outstanding geriatric emergency medicine.

EMED Toolkit Spotlight: Louis Stokes Cleveland VA Medical Center


In this new spotlight series, GEDC highlights hospitals that have successfully implemented the National Collaboratory to Address Elder Mistreatment’s Elder Mistreatment Emergency Department (EMED) Toolkit. The toolkit includes easy-to-use resources that will help emergency departments assess staff knowledge and practice, train staff to use simple tools to screen older adults for elder mistreatment and respond to suspected cases, and forge connections with community partners.


The Louis Stokes Cleveland VA Medical Center is part of the VA Northeast Ohio Health System and serves veterans from a large catchment area in 24 counties of Northeast Ohio. This medical center’s emergency department holds Level 1 GEDA Accreditation and reported 23,000 patient visits during the 2023 fiscal year. More than 50% of patients who visit the emergency department are 65 or older.


The Louis Stokes Cleveland VA Medical Center adapted and integrated the Elder Mistreatment Screening and Response Tool (EM-SART) into its health record and geriatric emergency department workflow in December 2020.


The hospital, which employs an interdisciplinary approach to geriatric emergency care, utilizes a Geri-Vet team consisting of an RN coordinator, designated RN staff, an Intermediate Care Technician (ICT) and two social workers. This team follows up with patients when their answers to triage questions trigger a consult.


“We see if there are ways that we can provide additional support and aim to be proactive in linking them to other support services and programs,” said Dyan Hagy, LISW-S, Senior Social Worker in Emergency Medicine and Transitional Community Care at the Louis Stokes Cleveland VA Medical Center.


The triage screening process for older adult patients who present to the Louis Stokes Cleveland VA Medical Center is comprehensive, and in addition to the EM-SART, it includes both cognitive and functional assessments such as ADLs, IADLs, falls, medications, living arrangements, transportation access, and financial and food insecurity.


“[An emergency department visit] is a opportunity to be able to screen, because sometimes, especially for the older adult, it’s the only time they’re leaving the house,” Hagy said. “It might be the only time they’re away from their caregiver or the person who is exploiting or abusing them.”


Hagy said that completing the EM-SART screening process early in a veteran’s emergency department visit allows the Geri-Vet team to connect a veteran in need of assistance with the appropriate resources in a more timely manner. This helps to prevent situations where a problem surfaces later in a veteran’s admission or even after additional emergency department visits.


The EM-SART, developed by the National Collaboratory to Address Elder Mistreatment in 2019, is designed to enable busy emergency department clinicians to quickly prescreen patients for signs of elder mistreatment with two questions. Based on patient responses, clinicians are prompted to ask follow-up questions.


A December 2022 article in Academic Emergency Medicine details the success of implementing the EM-SART at the Louis Stokes Cleveland VA Medical Center. During the pilot period, 251 veterans were screened, with nine (3.6%) positive for signs of elder mistreatment on the prescreen and five (2%) positive on the comprehensive screen.


Based on the program’s success, the medical center team has since worked to adapt the EM-SART for use in other VA settings.


“We created a work group and worked for about a year to adapt that screen, which is currently in the process to get approved at the national level to be used and implemented in all of the VA systems,” Hagy said.


The adapted version of the EM-SART can be used in any clinical setting by any provider, so it will not be exclusive to the emergency department.


“It helps [providers] understand the identifiers of elder abuse and know what to look for, how to document it and how to respond from there,” Hagy said. “It will also give us the opportunity to track and understand the extent of elder abuse in our veterans. This system-wide approach is the most rewarding part, and it’s definitely making an impact.”

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