Introduction of a Geriatric Nurse into ED - Essay Example

Introduction of a Geriatric Nurse into ED Name: Institution: Introduction Older people make up the larger portion of the population that is served by the emergency department (ED) that is majorly characterized by the several comorbid medical conditions with cognitive and impairment of the functions. The rate at which the older persons use the ED is higher than the rate at which the younger generation attends this has been mainly because their visit has a greater demand for high level of urgency making them to have longer stays in the ED (Parke & McCusker, 2008). They also experience a high rate of adverse health outcomes after they are discharged, making it more likely to have several admissions. However, it is very important to note that ED environment is not the best place to care for older patients this is because of several documented problems that are associated with quality of health care that is provided to the older patients. These problems may include: failure to identify and recognize problems that could be beneficial when careful assessment is conducted, failure to refer to the right community services and finally failure to communicate to the right physician on time when the problem is identified. Long- lasting solution to the increasing rate at which the ED is being utilized and the resulting overcrowding has made the attention to be focused on how the demands of the ED services can be reduced. The older population therefore becomes the natural target for these efforts. It is therefore of great concerned to determine whether the intervention of the comprehensive geriatric assessment (CGA) can affect the rate at which ED is being utilized. This paper seeks to analyze the introduction of the geriatric nurse into the ED looking at the costs and benefits that are associated with this intervention. Key issues with the geriatric intervention Over time the emergency department has experienced a steady increase in the size and the age of the elderly population that has contributed to greater effect on the delivery of the health care and other associated costs. Following the fast growth of the oldest segment of the elderly population, the impact is expected to grow bigger in the future. The emergency department is the only segment of the health care that provides critical services to older people since they are used as the emergency treatment center. The department is also used as a entry point of the highest technology a cute care where long term health care services are provided and the patients can access primary medical care throughout the day and night with a safety nets when transiting smoothly between the various care systems. However when the number of the elderly persons within the health care units continue to increase posing a great challenge of overcrowding in the ED, there should be a greater focus of the attention on the appropriateness and the patterns that can be used to provide emergency services to the older persons. The needs of the elderly people should be given a special care so that the effectiveness of the provision of the current model of the services is also enhanced for the elderly patients in the EDs. This will ensure that there is a systematic review of the pattern that is used to provide emergency services to these older adults. Considering the risk factors that may be associated with the adverse health outcomes in older ED patients and the effectiveness of the laid down intervention strategies that mainly target these older populations. CGA interventions have been classified based on their effect on health and functional outcomes such as hospital-based geriatric evaluation and management units, hospital –based consultation services. Other classification may include hospital-home assessment services which are meant for the patients that are discharged recently from the hospital. The intervention of the CGA in most cases involves a multidisciplinary team, but sometimes it may involve only a discipline which may be provided either in collaboration with referral to other services or sometimes as a part of the ongoing management program. Access to primary medical care is one of the factors that determine the utilization of the ED but in the case of the CGA intervention, it is the degree to which it is integrated with the primary medical care. It is therefore of great importance to undertake a controlled review of the CGA intervention for older hospital on a community based population that will make it possible to explore the characteristics of the intervention that may be attributed to ED utilization. Cost benefit evaluation Cost benefit evaluation becomes a very integral part that the emergency department must do to ensure that they determine the amount of money that is saved on the hospital beds. The evaluation must take care of the crude cost analysis where the costs associated with the patients receiving HINH care is compared to the cost of similar patients that are receiving usual services of the in-hospital care. The evaluation of the cost and the benefits that accrue to the hospital as a whole would help to determine the amount of the money that is saved from not admitting an ACF that are residents to the hospital. This measure involves defining the costs and the measuring benefits which over time has proved to be a complex task in most areas of health care. This case is very inherent and therefore the hospital must acknowledge the fact that with a very high rates of admission, even if the hospital beds are not fully utilized by the ACF residents someone else will come to utilized them. When undertaking the cost benefit analysis, the knowledge of the expert of economics and statistics may be required and even the knowledge of the health economist should also be factored in. The quality adjusted life years is also one of the factors that must be used within the evaluation to help give a very accurate measure of health outcome. This will help give a representation of the mortality probabilities and the assessment of the perceived well being at a point in time of the quality of life that older adults in ACF have. Data analysis Key elements that are guiding this intervention is the program evaluation of the structures within the hospitals, processes and the outcome approaches. The effectiveness of the HINH program models is the tool that will be used to look at the effectiveness of the nursing roles, the structures and the approaches of the treatment that require evaluation. Structural elements may involve the resources that are required for the program to be operational for example the patients, the organization itself and the staff (Suijker et al, 2012). The process elements may involve factors that will involve the role and the relationship requirement that will see to it that the program operate efficiently and effectively for example the medical care that is related and the interdependence role. Finally the outcome elements may include those factors that may make nursing sensitive for example in-hospital mortality, the length of the stay in the ED and even the representation to the ED following the re-admission to the hospital. The nurses collected the data based on the demographic feature, time that is required to complete the assessment and the healthcare usage in the previous years. Greater emphasis was put in the perceived quality of the support services, risk of the pressure that cause ulcers, depression, cognition and many others that may call for the referral in the emergency department. Some of the examples of the instruments that were administered include the following: geriatric depression scale, Lawton instrumental activities of the daily living scale and the water low risk assessment scale. Comparison was between the patients that were referred to provider of the community health care services and those that were not referred. About three hundred older patients were subjected through a comprehensive geriatric by the nurses for a period of three months this was mainly done for the patients that resided outside the healthcare units. Uncertainties that is associated with the intervention of introducing geriatric nurses into ED There are a lot of uncertainties in the use of the CGA intervention ranging from difficulty from hospital and ED based programs to be able to link the patients with programs of the communities since many patient use EDs, mainly because of the problems they have in accessing the primary medical care. Other reasons may also be of the high rate of the utilization of the ED in advance that poses a greater medical severity and or many functional dependencies among the available hospital based patient populations. Many of the elderly patients may have their conditions deteriorating in the hospitals and become independent in self care. As the formal geriatric inpatient can only assess and alleviate only the risk factors for the dependency, the time period for the assessment becomes slower than the rate at which the deterioration occurs, making it ideal for the assessment to just begin in the emergency department. A strategic research indicates that the geriatric consultative team that is mainly based on the emergency department have a faster response service pathway mainly to community based care making the nurse to assess non-targeted elders. Geriatric interventions should therefore focus their attention mostly to those in dyer need to ensure the very scarce resources are put into waste and the effects of the interventions are not diluted. Higher risk patients that require inpatient care should therefore be referred to the program of the inpatient geriatric as this will help to reduce mortality rates and inappropriate medication use that will eventually improve the quality of life and functional status. Other patients that is not admitted in the hospitals, but are in need of the multidisciplinary health care should also be considered and given a referral to the established geriatric programs of the outpatients. These programs have consistently shown improvement in the outcome, such as in the physical functioning, psychological health and even in the health related quality of life and in the reduced medical usage. Recommendations for Practice Operationalise and formalize HINH processes that will give a clear picture of the various roles and key responsibilities that are undertaken by each healthcare worker groups. Operationalisation will allow very important personnel to effectively communicate with each other as they try to highlight various areas that require improvement within the processes of the program. Making these processes to appear formal may help to reduce chances of missing out the potential programs where the HINH referral forms are completed automatically for all the ACF residents who are present at the ED. This will help to establish a very easy procedure to instigate since AFC residence will be automatically identified through the ED data base as they arrive at the ED. When all these communication and referral processes are operationalised and formalized, there will be effective and consistent transfer of information from one healthcare to another. Another recommendation is to establish the best practices and benchmarking through using the HINH model as a benchmark tool in order to guide the performance of the HINH programs within the entire hospital. Benchmarking can be used as the best tool in searching for the best practices that can be used to achieve the best and improved performance (Brand et al, 2004). Healthcare practices can be improved through looking at the best practice and documented principles that can be an input to developing policies that are based on the findings. If the quality practices that are obtained through benchmarking are reliable and effective then they can be utilized for the HINH programs which later can be transferred fully into other healthcare systems. The third recommendation that the hospitals can put into practice is to factor in HINH as a requirement for both hospitals and age care facilities as one of their accreditations. Accreditation is a process where the organization is assessed through an external body to ensure that the organization is delivering high quality health care services that are safe (Boltz, Capezuti & Shabbat, 2010). Both private and public hospitals must be made to participate in all the accreditation programs as a way of showing a strong commitment to attain quality improvement. These accreditations must involve assessment of all the key components of health care service delivery and implementation of the HINH programs that will ensure quality improvement for all the hospitals and the AFCs. Enhancing communication and the referral pathways between the staffs of the ED and the HINH programs where the program manager collaborates with a number of important healthcare personnel like the ACF nurses. Poor communication however can create gaps that may be a hindrance to the continuity of the healthcare practices and present an opportunity for the error to occur. When there is proper communication among various departments, the process of fixing the AFC residents GP a latter and putting the HINH service delivery report can be a great challenge. Conclusion In conclusion, it is clear that older people has their own distinct patterns that require a very keen consideration when provide health services to them and the care needs. Orientation of the disease episodic model care of the emergency health care units currently do not respond adequately to the complex health care need of the older patients. A lot of research need to be undertaken to determine whether the effectiveness of the screening and the intervention strategies that are targeting at risk older ED patients. There are a lot of uncertainties in the use of the CGA intervention ranging from difficulty from hospital and ED based programs to be able to link the patients with programs of the communities since many patient use EDs, mainly because of the problems they have in accessing the primary medical care. References Boltz, M., Capezuti, E., & Shabbat, N. (2010). Building a framework for a geriatric acute care model, Leadership in Health Services, 23(4), 334-360 doi:http://dx.doi.org/10.1108/17511871011079029 Brand, C. A., Jones, C. T., Lowe, A. J., Nielsen, D. A., Roberts, C. A., King, B. L., & Campbell, D. A. (2004), a transitional care service for elderly chronic disease patients at risk of readmission. Australian Health Review, 28(3), 275-84 Parke, B., & McCusker, J. (2008), Consensus-based policy recommendations for geriatric emergency care, International Journal of Health Care Quality Assurance, 21(4), 385-95 doi:http://dx.doi.org/10.1108/09526860810880199 Suijker, J. J., Buurman, B. M., ter Riet, G., van Rijn, M., de Haan, R.,J., de Rooij, S.,E., & Moll van Charante, E.,P. (2012), Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: Protocol of a cluster randomized trial, BMC Health Services Research, 12, 85, doi:http://dx.doi.org/10.1186/1472-6963-12-85 Read More