Advocate Health is a new, merged health system that includes Aurora, Advocate, Atrium and Wake Forest; the system is one of the 10 largest in the United States. It consists of 67 hospitals, nearly 6 million unique patients, almost 150,000 teammates and more than 21,000 physicians. The Advocate Midwest Region in Illinois and Wisconsin has 25 adult emergency departments and 18 of those emergency departments are implemented and accredited Geriatric Emergency Departments. Four more emergency departments are currently in the process of becoming accredited.
Beginning the GEDA Journey
The 25 adult emergency departments that represent the Advocate Midwest Region began their journey to GEDA accreditation in 2014 with Dr. Soryal’s, a geriatrician from Aurora West Allis Medical Center, recommending that improving hospital care should start in the emergency department.
In 2014, after the release of the Geriatric Emergency Department (GED) Guidelines, team members at Advocate Health held the nation’s first GED Bootcamp with the experts who would eventually form the Geriatric Emergency Department Collaborative, a learning, implementation, and research network co-founded by American College Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and The Society for Academic Emergency Medicine. The Advocate Heath team included Dr. Michael Malone, who has been tirelessly championing improved care for older adults for decades, Aaron Malsch (Senior Services Program Manager), Suzie Ryer (Senior Services Program Coordinator) and Chris Rubach (Project Coordinator).
Achieving Accreditation
The bootcamp helped the system jumpstart its implementation of the GED guidelines and led to accreditation for three emergency departments. Since that initial event, Advocate Health Midwest has implemented and accredited at 18 sites, with a cohort of four more sites currently pursuing accreditation.
“By creating a standardized program across 25 EDs we have been able to optimize workflow, processes, communication, teamwork, and the infrastructure needed to support our teams,” Malsch said.
Two sites, Aurora Medical Center Sheboygan County and Aurora Medical Center Oshkosh, have earned Level 2 GEDA accreditation, and two more sites have submitted their Level 2 applications. Aurora Medical Center Sheboygan County was the first in all of Wisconsin and Illinois to achieve this accreditation.
Serving Patients Beyond the ED
According to Malsch, Ryer and Rubach, the significance of implementing best practices in geriatric care is keeping patients successful in the community after visiting the emergency department. The team’s research revealed that Advocate Health’s GED patients have a 19 percent less chance of returning to the ED and an 11 percent less chance of being admitted to the hospital. This is especially impressive given the size of the system, which had 250,000 older adult emergency department encounters in 2022.
For Advocate Health, keeping patients successful in the community also includes connecting them to post-ED outpatient services. In the past year, the system’s GEDs have made more than 12,000 referrals to outpatient services including primary care, home care, orthopedics and physical therapy.
Gaining New Resources
The system has also successfully embedded physical therapists in 18 of its GEDs by performing ROI analyses that demonstrate the value of embedded physical therapists in bringing new resources to the ED staff, improving patient care, and diagnosing older adult patients after falls.
“We all work in healthcare to make a difference and improve outcomes for our patients, families, and communities,” Malsch said. “The GED program facilitates us individually and collectively to achieve our mission.”