Katie Buck is an Assistant Professor of Emergency Medicine and Lauren Southerland is the director of Clinical Research for Emergency Medicine at The Ohio State University Wexner Medical Centre. They are leaders in geriatric emergency care improvements and share their experience and lessons learned through the various waves of the COVID-19 Pandemic.
We oversee a large Geriatric ED program that has had Level 1 GEDA Accreditation since 2018 at The Ohio State University Wexner Medical Centre. And the hospital has had geriatrics programs for even longer. We were very well-established and (we think) successful before COVID. But when the pandemic hit we were no different from anyone else – everything was shut down and our department prepared to face what was coming. We were lucky that our department resumed most normal activities with appropriate precautions in summer 2020. We took this opportunity to reflect and examine what we could resume as before and what might need to change in this new world
One focus of our program is screening every older adult for delirium, elder abuse, and falls. At our worst, we were screening less than 10% after previously being >70% which is comparable other institutions our size. We are very proud that we are back to pre-COVID levels with a stronger program than before. Here are some of our lessons:
Boots on the ground are very helpful
We recruited self-nominated patient care technicians, residents, and nurses to serve as champions for outstanding geriatric care. They are our eyes and ears for successes and challenges as we cannot be there at all times, and we can’t understand the challenges from within each role.
Travel nurses must also be trained
As their presence in our department have increased, we have incorporated geriatric training into their orientation.
Use simple, helpful reminders
Reminders that your team find helpful are key. We incorporated a column on our ED track board that shows a red stop sign if the patient has not had all geriatric screens completed.
Re-engage stakeholders
COVID gave us some new opportunities! Specifically, it allowed us to re-engage some partners as the whole health system tried to avoid admissions due to extra tight bed availability.
Understand your unique “ecosystems”
Your department might be many small “civilizations.” Our ED has 86 single rooms and a total 110 “beds” across four pods. We have ensured that our geriatric champions are spread throughout the pods and shift times. We have also targeted these pods for different interventions as what works in one area might not work in others due to unique challenges and patient flow in each.
Engage Your Interdisciplinary Team
Critical elements were our interdisciplinary team approach with support of leadership at all levels, which helped us overcome the COVID challenges.
Motivation Matters
Figure out what motivates your team. Our team wanted Bravo points; these can be used to buy medical gear ranging from badge holders to jackets. We have been able to reward both individuals and pods with high performance leading to both motivation and healthy competition.
Know when to pull back
Perhaps most important, be sensitive to when you need to pull back and not push. Working in an emergency department is high-stress and can be even more so with large events such as COVID. Sometimes the best thing for your program and team members is to put the breaks on and not make a push.
As a result of these lessons and lots of hard work by our whole team, we are back at full strength. We have achieved re-accreditation and continue to grow our program. Remember, becoming an age-friendly or geriatric accredited emergency department is a journey. Every emergency department experiences bumps in the road but you can do it!
