Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Southerland, Lauren T.; Savage, Elizabeth L.; Duff, K; Caterino, Jeffrey M.; Bergados, Tina R.; Hunold, Katherine M.; Finnegan, Geoffrey I.; Archual, Gregory M.

doi:10.1111/acem.13998

Cited by 18 publications

(20 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 106‐bed academic, tertiary referral hospital ED includes a 15‐bed oncology area with oncology‐trained ED nurses and a 20‐bed Observation Unit area. It is an accredited Level 1 geriatric ED 16 …”

Section: Methodsmentioning

confidence: 99%

An implementation science approach to geriatric screening in an emergency department

Southerland

Hunold

Fossen

et al. 2021

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

Background: The Geriatric Emergency Department (ED) Guidelines recommend screening older adults during their ED visit for delirium, fall risk/safe mobility, and home safety needs. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) tool for preimplementation planning. Methods: The cross-sectional survey was conducted among ED nurses at an academic medical center. The survey was adapted from the CFIR Interview Guide Tool and consisted of 21 Likert scale questions based on four CFIR domains. Potential barriers identified by the survey were mapped to identify recommended implementation strategies using ERIC.Results: Forty-six of 160 potential participants (29%) responded. Intervention Characteristics: Nurses felt geriatric screening should be standard practice for all EDs (76.1% agreed some/very much) and that there was good evidence (67.4% agreed some/very much). Outer setting: The national and regional practices such as the existence of guidelines or similar practices in other hospitals were unknown to many (20.0%). Nurses did agree some/very much (64.4%) that the intervention was good for the hospital/health system. Inner Setting: 67.4% felt more staff or infrastructure and 63.0% felt more equipment were needed for the intervention. When asked to pick from a list of potential barriers, the most commonly chosen were motivational (I often do not remember (n = 27, 58.7%) and It is not a priority (n = 14, 30.4%)). The identified barriers were mapped using the ERIC tool to rate potential implementation strategies.Strategies to target culture change were identifying champions, improve adaptability, facilitate the nurses performing the intervention, and increase demand for the intervention.Conclusion: CFIR domains and ERIC tools are applicable to an ED intervention for older adults. This preimplementation process could be replicated in other EDs considering implementing geriatric screening.

show abstract

Section: Methodsmentioning

confidence: 99%

An implementation science approach to geriatric screening in an emergency department

Southerland

Hunold

Fossen

et al. 2021

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

show abstract

“…Physical therapists can bill for their ED evaluations, 49 and medication therapy management by pharmacists is covered by Medicare for patients with polypharmacy (receiving 5 or more medications). Southerland et al 50 evaluated the financial feasibility of multidisciplinary consultations in the ED and found that per workday a pharmacist is financially self-sustaining at 7.7 medication reconciliation consultations and a physical therapy is self-sustaining at 5.7 consultations. An average fall-related ED visit costs Medicare $5,000 to $6,000.…”

Section: Discussionmentioning

confidence: 99%

Can an Emergency Department–Initiated Intervention Prevent Subsequent Falls and Health Care Use in Older Adults? A Randomized Controlled Trial

Goldberg

Marks

Resnik

et al. 2020

Annals of Emergency Medicine

View full text Add to dashboard Cite

We determine whether an emergency department (ED)-initiated fall-prevention intervention can reduce subsequent fall-related and all-cause ED visits and hospitalizations in older adults. Methods:The Geriatric Acute and Post-acute Fall Prevention intervention was a randomized controlled trial conducted from January 2018 to October 2019. Participants at 2 urban academic EDs were randomly assigned (1:1) to an intervention or usual care arm. Intervention participants received a brief, tailored, structured, pharmacy and physical therapy consultation in the ED, with automated communication of the recommendations to their primary care physicians.Results: Of 284 study-eligible participants, 110 noninstitutionalized older adults (65 years) with a recent fall consented to participate; median age was 81 years, 67% were women, 94% were white, and 16.3% had cognitive impairment. Compared with usual care participants (n¼55), intervention participants (n¼55) were half as likely to experience a subsequent ED visit (adjusted incidence rate ratio 0.47 [95% CI 0.29 to 0.74]) and one third as likely to have fall-related ED visits (adjusted incidence rate ratio 0.34 [95% CI 0.15 to 0.76]) within 6 months. Intervention participants experienced half the rate of all hospitalizations (adjusted incidence rate ratio 0.57 [95% CI 0.31 to 1.04]), but confidence intervals were wide. There was no difference in fall-related hospitalizations between groups (adjusted incidence rate ratio 0.99 [95% CI 0.31 to 3.27]). Self-reported adherence to pharmacy and physical therapy recommendations was moderate; 73% of pharmacy recommendations were adhered to and 68% of physical therapy recommendations were followed. Conclusion:Geriatric Acute and Post-acute Fall Prevention, a postfall, in-ED, multidisciplinary intervention with pharmacists and physical therapists, reduced 6-month ED encounters in 2 urban EDs. The intervention could provide a model of care to other health care systems aiming to reduce costly and burdensome fall-related events in older adults. [

show abstract

“…Jesse M. Pines, MD, MBA 1,2 (pinesj@usacs.com) Simon Edginton, MD 1 Amer Z. Aldeen, MD 1 1 US Acute Care Solutions, Canton, OH, 2 Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA,…”

mentioning

confidence: 99%

“…In this issue of Academic Emergency Medicine , Southerland et al 1 describe a business model for staffing and equipment in a Level 1 accredited, academic geriatric emergency department (GED). The authors described program costs, including staff salaries for a geriatric nurse practitioner, pharmacist, and physical and occupational therapists.…”

mentioning

confidence: 99%

What We Can Do To Justify Hospital Investment in Geriatric Emergency Departments

Pines

Edginton²,

Aldeen³

2020

Academic Emergency Medicine

View full text Add to dashboard Cite

Southerland et al. 1 describe a business model for staffing and equipment in a Level 1 accredited, academic geriatric emergency department (GED). The authors described program costs, including staff salaries for a geriatric nurse practitioner, pharmacist, and physical and occupational therapists. Equipment costs were mobility aids, delirium aids, sensory aids, and personal care items. Reimbursement was the potential increase in billing from the addition of new staff. According to the authors, the additional GED staff become "self-sustaining" at specific workload thresholds. This meant that their costs would equal their potential billings at 7.1 daily consultations for the geriatric nurse practitioner, 7.7 daily medication reconciliations for the ED pharmacist, and 5.7 and 4.6 daily evaluations by physical and occupational therapists, respectively. Equipment costs were <$5,000. The authors also assessed how their GED impacted ED metrics and patient safety, finding no impact overall on ED throughput (e.g., prolonged lengths of stay), decisions to admit, or ED returns. However, fall rates in the ED and ED observation unit declined by about 25%. From the fall reductions, they estimated cost savings of~$80,000. This paper was written for a singular purpose: to help justify hospital investment in creating a GED. It involves return on investment (ROI), a common business term infrequently invoked in clinical circles. Financial ROI is defined as the financial gain (or loss) that may be realized through starting a new program. In the current environment, ROI is given inadequate

show abstract

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

Cited by 18 publications

References 10 publications

An implementation science approach to geriatric screening in an emergency department

An implementation science approach to geriatric screening in an emergency department

Can an Emergency Department–Initiated Intervention Prevent Subsequent Falls and Health Care Use in Older Adults? A Randomized Controlled Trial

What We Can Do To Justify Hospital Investment in Geriatric Emergency Departments

Contact Info

Product

Resources

About