EMED Toolkit Spotlight: Lyndon B. Johnson Hospital

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.

Lyndon B. Johnson Hospital is a major teaching hospital for McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). The hospital holds Level 3 GEDA accreditation, and in 2017, it began implementing the EDC’s Elder Mistreatment Emergency Department Toolkit as part of the geriatric emergency department accreditation process. Approximately 15% of the emergency department’s patients are aged 65 or older, and these patients account for 800 visits to the emergency department per month.


Lyndon B. Johnson Hospital was among the first hospitals to pilot the Elder Mistreatment Emergency Department Toolkit after its development. When the pilot study finished, emergency department clinicians continued to utilize the Elder Mistreatment Screening and Response Tool (EM-SART) to screen patients for elder mistreatment by free-texting responses in the electronic health record.


In the latest phase of revamping the toolkit’s use in the emergency department through a grant from the John A. Hartford Foundation, the hospital team programmed the EM-SART into EPIC to ensure a seamless integration into triage.


“The goal is that the bedside nurse is going to be doing that initial screening, but we have a pop-up that will come up for any nurse logging into that patient’s chart until they’ve been screened as a reminder to do the screening,” said Charles Maddow, director of emergency geriatrics for UTHealth Houston. “We are getting about a 90% screening rate, which is really good.”


Maddow said the hospital has an estimated 5% of positive responses to the EM-SART’s pre-screen, and a couple of patients have been sent through to an APS referral after the screening positive on the second part of the screen.


The emergency department’s social worker completes the second part of the EM-SART, and according to Maddow, this is where his emergency department diverges from the second portion of the EM-SART.

“We have it programmed into EPIC but it hasn’t really matched with the workflow of what the social workers do,” Maddow said. “They are continuing to do their evaluation freeform.”


Maddow said that integrating the EM-SART into the hospital’s screening process was a smooth, quick transition.


“Importantly, there hasn’t been any negative aspect to it, and that’s tough because there’s a lot of screening fatigue out there,” Maddow said. “There’s a lot of screening going on and for it not to be perceived as adding on a burden is really a big positive.”

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