Senior-focused EDs: Plenty of buzz, but outcomes/costs TBD
One indication that senior-focused emergency care settings are catching on: For the first time, geriatric EDs have appeared on the Plymouth Meeting, PA-based Emergency Care Research Institute’s (ECRI) Top 10 Hospital C-Suite Watch List, an annual list of new technologies and health system developments that providers and policy makers should "think carefully about," according to ECRI. (To download a copy of the report, visit www.ECRI.org, and click on the C-Suite Watch List under "Hot Topic Resources" on the right. )
In its comments on geriatric EDs, ECRI notes that in addition to the existence of at least 50 senior-focused EDs, more than 100 of these facilities are in development at hospital systems across the country. But the report also emphasizes that there is not much data to show that geriatric EDs are cost-effective.
"There are some studies showing reduced admissions to an intensive care unit but there really isn’t an awful lot of material out there saying that these are a bona fide plus on the financial charts," explains Robert Maliff, MBA, the director of ECRI’s applied solutions group. "I think what we are seeing is that as health care transitions from a fee-for-service environment to a value-based purchasing environment and the ACO [accountable care organization] model there is a lot of interest in these."
Whether geriatric EDs will prove to be successful under the newer financial models is an open question, but Maliff notes that many health care organizations clearly believe that the approach will work. "They are thinking that from a patient perspective they will be successful, from a financial perspective that they will beneficial, and that from a marketing perspective they will be successful as well," he observes.
But that doesn’t mean that all hospitals, large and small, should immediately start figuring out how to open senior-focused EDs of their own. For one thing, Maliff stresses that hospitals need to conduct market analyses to see how many senior-aged patients a new facility would likely serve, and they also need to consider the costs.
"The hard-core infrastructure of a senior ED, whether it is a totally separate ED or a wing in the ED dedicated to seniors, is capital intensive," says Maliff. Indeed, ECRI’s C-Suite Watch List report notes that the financial outlay required to build a new facility can run into the millions, although costs can vary greatly depending on an institution’s needs and resources.
For many organizations, a better place to begin the process of developing a senior-friendly ED is by assessing whether you have staff in place who are trained in geriatric issues. "Do you have a geriatric nurse or a geriatric social worker who is able to support these patients when they present to the ED?" notes Maliff. "That is an important factor."
