Sanon Martine, Hwang Ula, Abraham Gallane, Goldhirsch Suzanne, Richardson Lynne D
Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, New York, NY 10029, USA.
Icahn School of Medicine at Mount Sinai Department of Emergency Medicine, New York, NY 10029, USA.
Geriatrics (Basel). 2019 Feb 21;4(1):24. doi: 10.3390/geriatrics4010024.
The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.
急诊科在改善老年人护理及影响患者预后轨迹方面具有独特地位。西奈山医院急诊科每年接待15000多名65岁以上的患者。2012年至2015年期间，在专门的老年急诊科（GED）开展的急诊护理复制了老年急性护理（ACE）模式，重点评估常见老年综合征，并为高危患者召开每日综合多学科团队（IDT）会议。IDT由一名急诊医生、老年病医生、过渡护理护士（TCN）或老年护理执业医师（NP）、急诊科护士、社会工作者（SW）、药剂师（RX）和物理治疗师（PT）组成，为易患疾病、有急诊复诊风险、功能衰退或可能避免的住院风险的脆弱老年人制定全面护理计划。使用高危老年人识别（ISAR）筛查来识别患者，随后进行老年评估，以协助对急诊科的老年人进行评估。IDT平均每天评估38名患者，其中约30%的患者在IDT查房期间进行正式讨论。IDT在功能和认知、心理社会、家庭安全和药物评估方面的意见影响了关于住院、护理过渡、获取社区资源和药物管理的决策。本文描述了老年急诊医学多学科团队作为一种创新的ACE护理模式，对到急诊科就诊的老年人所发挥的作用。
