Hospitals in pursuit of excellence

Holy Cross Hospital Geriatric Emergency Department

Holy Cross Hospital
Silver Spring, MD
425 Beds

The Problem
Holy Cross is a not-for-profit teaching hospital located just north of Washington, DC. Part of a large, integrated health system, the institution established the first senior emergency center in the country, to treat patients 65 and older who are experiencing acute, but not life threatening issues.

The Solution
Recognizing that this population demands a unique approach to emergency care, the geriatric emergency department is located immediately off to the side of the regular emergency department. Patients are triaged and then sent to this department. All staff received specialized training in common health issues facing the geriatric population, allowing for quicker diagnosis and standardized treatment protocols. For example, any patient that is on five or more medications are immediately referred for a polypharmacy consult in which a pharmacist reviews the identified drugs and doses to understand if there was an undesired interaction. Additionally, once a patient is stabilized in the emergency department, nurses screen for cognitive loss, depression, neglect and alcohol or drug abuse in addition to a fall evaluation.

The Holy Cross geriatric ED is reimbursed on a fee-for-service system with diagnosis related group-based payment upon admission. The development of the specialized center was subsidized at a cost of under $200,000.

The Result
Of more than 1,000 surveyed patients, 98 percent rated their geriatric emergency care as “excellent.” One-ninth of the patients were prescribed five or more medications, and through the pharmacist referral, it was recognized that 20 percent of that population were taking inappropriate medications or doses. Inpatient volume increased, signifying appropriate admissions and return emergency department visits within 72 hours decreased to 3 percent.

This case study was originally featured in the HPOE guide: "Caring for Vulnerable Populations," published January, 2012.