Identifying high-risk elders in the emergency department

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For senior citizens, a visit to the hospital emergency department can be frightening enough, even with a minor injury. But what if you are a 70-year-old with a fractured wrist who returns home to face such daunting tasks as preparing meals, cleaning and bathing? Locating the community organizations that will help can be a real challenge.

At Joseph Brant, there is a new hospital initiative ready to fill in the gap.

The high-risk elderly assessment fellowship is a three-month pilot project spearheaded by Trish Corbett, an emergency department charge nurse. Having worked in the ER for over 11 years, Corbett has seen first hand the challenges faced by the well-elderly – seniors who live and thrive in their own homes, but who are in sudden need of help due to a fractured wrist or bout of pneumonia. While these seniors are well enough to return home to recuperate from their injury, they often are in need of some help to make the first few days or weeks easier, from organizations such as the Red Cross, Meals on Wheels, a visiting nurse or homemaker.

“There is so much support for this initiative in the community,” says Corbett. “It has been overwhelming.”

As a lifelong learner, Corbett proposed utilizing a unique fellowship offered by the Registered Nurses Association of Ontario (RNAO). With funds contributed by both the RNAO and Joseph Brant Memorial Hospital, Corbett recommended that the three-month fellowship project cover three stages – research, education and implementation. Corbett was encouraged by her mentor, geriatric clinical nurse specialist Sue Fornataro.

“In my role as a geriatric nurse specialist, I consult with the patient and often the family to help plan a safe discharge,” says Fornataro. “But for seniors who enter and exit the hospital only through the ER, we have very little opportunity to consult. Creating a system to look for elders, who may be at risk at home, while they are in the ER, gives us an opportunity to identify those who may benefit from community services. Many seniors are unaware of how many organizations are there to help them.”

Corbett spent the first few weeks of her fellowship visiting other hospitals that currently have geriatric nurses or geriatric initiatives in the ER, including North York, Markham-Stouffville, Henderson and Sunnybrook. Incorporating ideas from other hospitals with her own experience and suggestions from community organizations, Corbett introduced a screening tool to the ER nursing staff for geriatric patients.

“This screening tool will identify risk factors for those seniors potentially returning home,” says Corbett. “Without it, we may not always identify those who would be vulnerable and in need of some help.”

The second stage, education, involved presenting these screening tools to her fellow ER nurses. These education sessions included an occupational therapist presenting a mini-mental screening, Fornataro speaking on delirium, dementia and depression, and Corbett covering the assessment of elderly patients and information about community programs.

The final stage, implementation, will involve utilizing the screening tool on all elderly patients who enter the ER, referring those at risk to the ER social worker for further assessment of their needs. Their wellness after discharge will be enhanced by referrals to helping organizations and may be evaluated with follow-up phone calls.

The fellowship will be completed in July. Not only will Joseph Brant have an invaluable aid to insuring a safe discharge into the community, Corbett will have the satisfaction of knowing she’s made a difference – not just one-to-one with a single patient, but with all seniors who enter Joseph Brant’s emergency department.