UAB Hospital is home to the only accredited geriatric ED in Alabama, the first one in the Southeast and the 17th Level 1 geriatric ED in the world.
(Photography: Andrea Mabry)The American College of Emergency Physicians has named UAB Hospital-Highlands Emergency Department a Level 1 Geriatric Emergency Department, making the University of Alabama at Birmingham home to the only accredited geriatric ED in Alabama, the first one in the Southeast and just the 17th Level 1 ED in the world.
“We are so honored to be able to provide this service to our geriatric patients,” said Dag Shapshak, M.D., co-director of the Wound Care and Hyperbaric Medicine Program. “For a long time, we have had all these different pieces of the puzzle, but this was the final piece in becoming the region’s first wholly integrated age-friendly health care system. Now we are able to streamline geriatric care from inpatient to outpatient to help reduce lengths of stay and avoid unnecessary hospital admissions.”
This is the highest level of accreditation a hospital can receive from the American College of Emergency Physicians and recognizes UAB Medicine’s commitment to providing a high-functioning emergency department for older adults where everything from the processes to the facilities are tailored specifically to meet their needs.
The geriatric ED is part of a specialized pathway for older adults to allow them to feel more comfortable during their visit. In the ED, patients will be placed in separate enclosed rooms with curtains, sound-absorbing materials and other accommodations to reduce noise. The geriatric ED is also equipped with LED lighting with bi-level dimming, non-slip flooring, handrails, and color-contrasting walls, floors and doors. Patients will also find safe mobility equipment, comfortable furniture, analog clocks on the walls, and wall-to-wall art of local scenery to remind them of the current time and location. The facility also offers a variety of resources such as delirium prevention toolkits to help reduce instances of confusion.
Upon arrival to the ED, older adults will undergo an Identification of Seniors at Risk assessment. The ISAR results assist in identifying patients who may need a more comprehensive assessment in the ED. Based on a patient’s score, a geriatric emergency nursing intervention expert, or GENIE nurse, may come in and complete additional screenings to identify any needs that must be met before the patient can be safely discharged. The GENIE nurse will share the screening results with the medical team to determine an appropriate treatment plan.
The geriatric ED is equipped with LED lighting with bi-level dimming, non-slip flooring, wall-to-wall art, and color-contrasting walls, floors and doors.
(Photography: Morgan Gaghen)“Research shows that geriatric patients do not recover as easily when they are taken out of the familiarity of their home environment,” said Brendhan Buckingham, M.D., medical director of UAB Hospital-Highlands Emergency Department. “Our primary goal through the geriatric ED is to provide our patients with the services they need to be able to recover at home and live as independently as possible.”
GENIE nurses are specially trained in geriatric care and assist with coordinating a range of services needed at home, including physical therapy, home health, social work services and medical equipment delivery. GENIE nurses also conduct follow-up calls to ensure the patient is getting the treatment they need. By organizing these outpatient services, patients can avoid unnecessary hospital admissions and experience a continuity of care from the time they enter the geriatric ED to the time they are sent home.
“We always want to ensure our older adults are getting the best care possible for their situation, even when they are back at home,” said Emily Simmons, MSN, R.N., CNL, program development manager and NICHE coordinator. “The geriatric ED bridges the gap between our Acute Care for Elders Unit and the emergency department and allows us to quickly identify a patient’s needs and get them connected with the right resources in our system.”
The ACE Unit is a model of inpatient geriatric care that utilizes an interdisciplinary team of nurses and physicians trained in geriatrics to proactively manage geriatric syndromes, such as cognitive impairment, risk of falls, risk of confusion and functional decline, while a hospitalist physician manages each patient’s acute medical diagnosis.
The Geriatric Emergency Department Accreditation prioritizes geriatric-focused education and multidisciplinary staffing, smooth transitions of care from the ED to other settings (inpatient, home, community-based care, rehabilitation, long-term care), standardized approaches to care that address common geriatric issues, and geriatric-focused quality improvement and enhancements of the hospital environment.
This accreditation was a three-year effort led by UAB’s Department of Emergency Medicine in collaboration with the Division of Gerontology, Geriatrics and Palliative Care, Rehabilitation Medicine and Therapy Services, pharmacy services, social work services, and nursing.
“This was truly a collaborative effort that involved multiple disciplines across UAB,” said Frank Sortino, UAB Hospital-Highlands administrator. “When the pandemic began, it would have been easy to put this on pause; but everyone was really committed to making this happen to continue providing the highest quality of care for our geriatric patients.”
To learn more about ACEP’s Geriatric Emergency Department Accreditation, click here.