19 min
Kevin Biese, MD & Megan Donovan, MBA - The Value of Geriatric Emergency Departments Pt. 2 Move to Value
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- Medicine
In this episode we continue our conversation with Doctor Kevin Biese and Megan Donovan about the role that Geriatric Emergency Department have in the move to value and how it touches all aspects of the quadruple aim.
Transcript:
What are the different staffing components that comprise the integrated care of a GED and what if any special training is preferred or required for physicians and APPs working in GEDs?
Kevin: Awesome. So, there are 3 levels of accreditation for geriatric EDs. Level one is the highest level, like a trauma center, it's how we think; level 2 is silver; level 3 is bronze. All three of these levels have people at them that would be interested, and this is the theme I want to come back to, perhaps even eager to connect with ACO leaders in their neighborhood. They don't, probably I'll come back but, they probably don't know who you are, or they might not even be able to tell you what an ACO stands for, but these are friends you just haven't met yet. All three of them have that. All three of these levels have champion nurses and champion physicians, and those are the friends you haven't met yet. People that are like, yes this is important to us, they've had some additional education in geriatrics, depending on what level is how many hours of geriatric emergency medicine. We're talking about care transitions, polypharmacy, falls as a syndrome, etc. The two higher levels, silver and gold, two and one, also have all their staff has some training in geriatric emergency care, so that they are more, the different language, there's a different culture. The things that are being talked about after an older person has a fall are a little different than a traditional ED, and everyone is acquainted with that language and that culture even if it's not their specific expertise. Level 2 and level 1’s have requirements for either all or some of, depending on whether they're a level one or level two, of physical therapy, occupational therapy, pharmacists, and care management, or social work, within that emergency department able to be turned towards the needs of older adults.
So, what you'll find to varying degrees is a more interdisciplinary team with additional training in geriatric emergency medicine. And again, how much is contingent upon what level they got accredited at. But I can't say this loudly enough, a Level 3 is meant to be in the zone of proximal development at all 5,000 EDs in the country. It's not that hard to become a Level 3. However, you are doing a quality improvement project for older adults, and you have a champion nursing, a champion physician, which means that there are people there that would want to hear from people like you and you can work together to figure out. They've tilled the soil. They may not have grown the orchard yet, but the soil is tilled for collaborative efforts, such as you would be interested in pursuing if you’re listening to this podcast. Like huh, a whole bunch of beneficiaries go to Saint elsewhere emergency department. Oh, look there are Level 3 geriatric ED. Shouldn't we connect these dots somehow. Answer yes. Champion nurse, champion physician is who you want to connect them with.
What is the role of a transitional care nurse in the GED and how does this role impact value-based care?
Kevin: Um so, Megan was just kind enough to cite some of the stats that come with geriatric emergency department, which is decreased admissions, decreased readmissions, improved patient satisfaction, and not surprisingly, decreased cost associated with these interventions.
The care transitions nurse is what makes that possible. They're really the quarterback. Different geriatric EDs call that person by different names. Some of them call them the genie nurse, or the gem nurse, but essentially these geriatric EDs identify who
In this episode we continue our conversation with Doctor Kevin Biese and Megan Donovan about the role that Geriatric Emergency Department have in the move to value and how it touches all aspects of the quadruple aim.
Transcript:
What are the different staffing components that comprise the integrated care of a GED and what if any special training is preferred or required for physicians and APPs working in GEDs?
Kevin: Awesome. So, there are 3 levels of accreditation for geriatric EDs. Level one is the highest level, like a trauma center, it's how we think; level 2 is silver; level 3 is bronze. All three of these levels have people at them that would be interested, and this is the theme I want to come back to, perhaps even eager to connect with ACO leaders in their neighborhood. They don't, probably I'll come back but, they probably don't know who you are, or they might not even be able to tell you what an ACO stands for, but these are friends you just haven't met yet. All three of them have that. All three of these levels have champion nurses and champion physicians, and those are the friends you haven't met yet. People that are like, yes this is important to us, they've had some additional education in geriatrics, depending on what level is how many hours of geriatric emergency medicine. We're talking about care transitions, polypharmacy, falls as a syndrome, etc. The two higher levels, silver and gold, two and one, also have all their staff has some training in geriatric emergency care, so that they are more, the different language, there's a different culture. The things that are being talked about after an older person has a fall are a little different than a traditional ED, and everyone is acquainted with that language and that culture even if it's not their specific expertise. Level 2 and level 1’s have requirements for either all or some of, depending on whether they're a level one or level two, of physical therapy, occupational therapy, pharmacists, and care management, or social work, within that emergency department able to be turned towards the needs of older adults.
So, what you'll find to varying degrees is a more interdisciplinary team with additional training in geriatric emergency medicine. And again, how much is contingent upon what level they got accredited at. But I can't say this loudly enough, a Level 3 is meant to be in the zone of proximal development at all 5,000 EDs in the country. It's not that hard to become a Level 3. However, you are doing a quality improvement project for older adults, and you have a champion nursing, a champion physician, which means that there are people there that would want to hear from people like you and you can work together to figure out. They've tilled the soil. They may not have grown the orchard yet, but the soil is tilled for collaborative efforts, such as you would be interested in pursuing if you’re listening to this podcast. Like huh, a whole bunch of beneficiaries go to Saint elsewhere emergency department. Oh, look there are Level 3 geriatric ED. Shouldn't we connect these dots somehow. Answer yes. Champion nurse, champion physician is who you want to connect them with.
What is the role of a transitional care nurse in the GED and how does this role impact value-based care?
Kevin: Um so, Megan was just kind enough to cite some of the stats that come with geriatric emergency department, which is decreased admissions, decreased readmissions, improved patient satisfaction, and not surprisingly, decreased cost associated with these interventions.
The care transitions nurse is what makes that possible. They're really the quarterback. Different geriatric EDs call that person by different names. Some of them call them the genie nurse, or the gem nurse, but essentially these geriatric EDs identify who
19 min