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.
Inova Fair Oaks Hospital is one of five hospitals in the Inova Health System, a leading nonprofit healthcare provider in Northern Virginia. The hospital’s signature lines of service include spine, weight loss, joint replacement and non-invasive surgery. Between 30-38% of the hospital’s patients are 65 or older, and Inova Fair Oaks Hospital is currently pursuing GEDA accreditation. The hospital has recently begun piloting the Elder Mistreatment Emergency Department Toolkit in its emergency department.
The drive to address elder mistreatment in the Inova Fair Oaks Hospital Emergency Department began when clinicians sought a better way to assist older adults who displayed signs of elder mistreatment.
“We had been seeing older adults in our emergency room and trying to accurately assess their needs and address some of the concerns that we were seeing when they were coming in, whether those be abuse, self-neglect or possible financial exploitation,” said Maurice Haskins, clinical social worker for the Inova Fair Oaks Hospital Emergency Department. “We were trying to find a way to capture that information, and I was introduced to the [National Collaboratory to Address Elder Mistreatment Mentorship Program] serendipitously.”
Haskins was able to utilize resources from the National Collaboratory to Address Elder Mistreatment (NCAEM) to build a case for implementing the EMED Toolkit in his emergency department. Namely, he distributed the toolkit’s survey among his colleagues and collected 30 responses to create buy-in for the team.
Haskins’ mentor in the NCAEM program suggested that Haskins present the Elder Mistreatment Emergency Department Toolkit as a project that would help Inova Fair Oaks Hospital earn GEDA accreditation.
“One of our sister sites received GEDA accreditation one or two years ago, so there was a demonstrated opportunity to show that it was feasible to get done,” Haskins said. “I was able to have a meeting with our leadership team in the emergency room about the benefits and get their feedback on some concerns or challenges that could arise in the process.”
Haskins advises that hospitals considering a pilot of the EMED Toolkit take advantage of the NCAEM’s resources, which also include feasibility studies that can be used as a baseline to present to hospital staff.
The Inova Fair Oaks Emergency Department team has only recently introduced the Elder Mistreatment Screening and Response Tool (EM-SART) into its triage process, and as a result, there have been some challenges along the way.
“Early on, some of the challenges were around feasibility within the nurses’ workload,” Haskins said. “We were introducing a new task within the multiple tasks they have to get done when they are triaging patients in the emergency room.”
To address this challenge, the hospital streamlined the screening to simplify the assessments that nurses would conduct during triage. Nurses still complete the initial elder mistreatment screening, but patients who screen positive for elder mistreatment are now further assessed by a social worker or case manager.
An additional challenge of screening patients for elder mistreatment has been determining what to do to assist patients who are experiencing elder mistreatment, Haskins said.
“It’s one thing for somebody to screen positive for abuse, and you call APS to make a referral,” Haskins said. “The second part of that is what do you do with the older adult who’s in front of you.”
This predicament could lead to more social admissions to the hospital and create an undue burden on the healthcare system as a whole. To find a solution to this challenge, Haskins has been employing his clinical skills to identify interventions within the context of the screening that can serve older adults in need of assistance.
“We’ve categorized these interventions, and a lot of it has to do with gaps in resources or gaps in care needs more than actual abuse or neglect from an external person,” Haskins said. “We’ve been able to demonstrate a plan and interventions that we can work through to mitigate people’s concerns.”
Throughout the process of piloting the EMED Toolkit in his emergency department, Haskins has relied on the NCAEM Mentorship Program for guidance in addressing the challenges along the way. One of Haskins’ mentors, Dr. Jason Burnett, was even able to meet with Haskins’ ED team to offer technical assistance and training.
“The mentorship has been critical, I think, to my growth in the last 8 or 9 months in this space, and being able to really understand the epidemic that elder abuse is around the country,” Haskins said.
Check out GEDC elder mistreatment resources