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

Abstract

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

Impact of the geriatric emergency medicine specialist intervention on final emergency department disposition

“…With an aging population, embedded consult programs are vital for delivering specialized geriatric care in the ED; however, evidence supporting their effectiveness is still growing 35–37 . We aimed to augment the gap in knowledge about the impact of our GEMS program on admissions.…”

Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department

“…While implementing all GED guidelines may be infeasible in some contexts due to the lack of resources and administrative support, focused interventions on high impact clinical conditions, such as for falls, delirium, or polypharmacy, will help improve care in this population 5 . The aging population necessitates innovation in emergency medicine to ensure older adults receive high‐quality care while decreasing costs 6 …”

“…5 The aging population necessitates innovation in emergency medicine to ensure older adults receive high-quality care while decreasing costs. 6 One GED mechanism employed to improve outcomes for older adults is Comprehensive Geriatric Assessment (CGA). CGA is defined as a "multi-dimensional, multidisciplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older people with frailty so that a coordinated and integrated plan for treatment and follow-up can be developed."…”

Making the Case for a Geriatric Emergency Department

“…Once they're at an ED, there's strong evidence that they use more resources per visit, are more likely to get expensive tests with advanced imaging, are more likely to be admitted, and are more likely to suffer healthcare-related harms. Adopting a new approach to their carewith sometimes small changes in structure and processescan have a big impact in terms of improved outcomes for patients while saving money for your hospital [1][2][3]. As the demographic Silver Boom continues over the next two decades, the changes presented in this book are essential both on moral grounds and if you want to achieve financial sustainability and ongoing quality of care in your ED.…”