This article was reproduced with permission from the authors. Original article from geriatric-ed.com.
The Hospital
Geraldton District Hospital is an Acute Care/Emergency Hospital and Long Term Care (LTC) Home with 23 acute care beds and 26 LTC beds. The hospital serves a population of approximately 5700 in the Thunder Bay District with a catchment area of over 2500km2. The senior population (age 65+) is 12% of the total population of the area. Geraldton also serves four First Nations reserves (18.4% of population), including one fly-in. This is the story of a Northwest Ontario community, near Thunder bay.
The Improvement
The goal is to improve the overall level of care for our elderly population in the emergency department through increasing their functionality on discharge and reducing readmissions. In particular they targeted high risk patients over the age of 65.
Improvement Initiatives
The team at Geraldton chose the following improvements to be added to their ED:
- Screening for High Risk in the ED using ISAR tool. A high risk patient automatically triggered a home care referral and a social worker consult.
- Senior-Friendly Order Sets – particularly focused on medications to ensure they do not increase/contribute to rates of delirium on admission.
- Delirium Screening (CAM- Confusion Assessment Method)
- Functional Assessments (Barthel Index) – assess and support patients from admission to discharge
Outcomes
One of the outcomes measures included the % of ALC days because they noticed a significant increase (from 38.4% to 50.6% in one year). They also measured the average length of stay and ED return visit rate.
They planned to engage staff through the use of PDSA (Plan, Do, Study, Act) cycles and staff huddles to promote elderly friendly initiatives.
They brilliantly involved a patient caregiver advisor in the generation of all improvement activities.
Finally, being a small community center seemed to have made things easier for this team. There was more cohesion, it was easier to reach the whole staff in a very short time and their senior leadership was more accessible.
Contributing Faculty
