System Spotlight: UC San Diego Health

UC San Diego Health is repeatedly ranked the No. 1 healthcare system in San Diego, and the system’s mission “to deliver outstanding patient care through commitment to the community, groundbreaking research and inspired teaching” translates to its care for older adult patients in San Diego County. The Gary and Mary West Emergency Department, featuring a state-of-the-art,19-bed senior emergency care unit designed for older adult patients, is located on the system’s La Jolla Medical Campus, and boasts Level-1 GEDA accreditation. All of UC San Diego Health’s hospitals hold some level of GEDA accreditation, and the system led an effort to ensure that all emergency departments in San Diego County earned GEDA accreditation. 

In recent years, UC San Diego Health has prioritized innovation and excellence in geriatric emergency medicine. Developed in collaboration with the West Health Institute and funded by the Gary and Mary West Foundation, the Gary and Mary West Senior Emergency Care Unit located on the system’s La Jolla Medical Campus opened its doors in 2019. 

The unit comprises 19 of 50 total beds and is specially designed to meet the unique needs of older adult patients who visit the emergency department. 

“Our goal was to develop unique, innovative processes in this incredible unit and serve as a gold standard for geriatric emergency care,” said Vaishal Tolia, MD, director of the Gary and Mary West Senior Emergency Care Unit. “We are just fortunate that [the West Health Institute] is located in La Jolla, and they have provided us funding and a collaborative partnership, which helped develop what we have today.”

Even more important than building the state-of-the-art emergency care unit is establishing care pathways and processes that not only lead to better care for older adult patients, but also cultivate a team culture, Tolia said. 

Nearly every older adult patient who goes through triage in the Gary and Mary West Emergency Department is screened using the Identifying Seniors at Risk (ISAR) Screening Tool. The emergency department also utilizes Geriatric Emergency Nursing Initiative Expert (GENIE) nurses who review each patient’s ISAR score and are empowered to put in referrals for patients who require more urgent evaluation or follow-up. 

Patients who are 65 or older and who score a three on the ISAR scale – with a score of one being the most severe and 5 being less acute – are prioritized in this setting.

“Three is the middle road, and those are the patients we’ll prioritize because sometimes the right interventions, assessments and referrals can avoid an admission,” Tolia said. “That’s kind of our North Star – can we change the trajectory in order to avoid hospitalization for some of these patients?”

The emergency department care team engages in a collaborative approach to caring for older adult patients and calls upon the GENIE nurses, as well as physical therapists, pharmacists, social workers and case managers to provide their expertise. The care that older adult patients receive extends beyond a visit to the emergency department.

“The system we’ve developed has also brought better care coordination to the emergency department, so that we can make more referrals and provide more data to our outpatient team members to get people connected to resources that they need after they leave the emergency department,” Tolia said. 

Implementing best practices in geriatric emergency medicine has had a broad impact throughout the healthcare system and has improved the experience for patients and their families, as well as fostered excitement among members of the care team. 

“It’s so much about the people and the passion that our team has to really look after seniors and go the extra mile,” Tolia said. “It’s an incredible thing to see how everyone comes together and works with the physicians. It’s a team-based approach, and I think that’s been the heart and soul of our program.”