Emergency care is one of the key areas of concern when it comes to geriatric patients. On the one hand, elderly patients are more vulnerable to the risks of hospitalization and hospital readmission due to their age. On the other hand, the emergency care delivered to this group of patients should be readjusted and tailored to their unique health and wellness needs. Elderly individuals admitted to emergency departments (EDs) typically require more comprehensive and holistic approaches to care than their younger counterparts. However, ED physicians are not always positioned to address the peculiar health needs of older adults. The issue to be considered in this project is the quality of emergency care provided to the elderly and the role of an adult-gerontology nurse practitioner in improving outcomes for the geriatric patients admitted to the ED.
The issue of emergency care for geriatric patients is significant for several reasons. To begin with, due to changing population demographics, the number of elderly patients admitted to EDs continues to increase. According to McCabe and Kennelly (2015), “patients aged 65 years and over account for approximately 20% of emergency department (ED) presentations. It is projected that this figure will rise substantially in the coming decades” (p. 45). By 2030, every fourth Medicare beneficiary will be 85 years and older, and it is likely that older patients will make up to 70 percent of all emergency readmissions in the healthcare system (McCabe & Kennelly, 2015). The situation is further aggravated by the growing number of elderly people with chronic conditions and related comorbidities, which contribute to the burden of emergency care in the U.S. As such, ED nurses must be ready to manage the growing number of geriatric patients who are admitted to emergency care.
Furthermore, elderly clients who arrive to EDs typically require more complex and sophisticated care, as compared with their younger counterparts. They utilize proportionally more services in EDs, as compared with other age groups (Boltz et al., 2013; Ellis, Marshall, & Ritchie, 2014). Whenever a geriatric patient is admitted to an ED, he or she will stay longer, require more diagnostic tests, and experience higher hospital admission rates than younger patients (Boltz et al., 2013). Older adults brought to EDs are usually sicker than younger patients, which is why they have higher rates of hospital readmissions due to more frequent exacerbations of chronic conditions or the development of new comorbidities (Ellis et al., 2014). The costs of managing geriatric patients in the ED are also higher than those of younger patients (Ellis et al., 2014), and even when adequate care is provided, these clients are still likely to have poorer health outcomes as compared with patients from other age groups.
Finally, the growing number of older patients necessitates the development of new models of care. Here, Hwang et al. (2013) speak of the need to redesign emergency service settings in ways that would improve the quality of geriatric emergency care. Hwang et al. (2013) even used the term “geriatricizing” EDs, implying that the current systems and models of emergency care fail to meet the health needs of geriatric patients. Therefore, it is important to revisit the relevance of including an adult-gerontology advanced nurse practitioner instead of an ED physician to close the existing gaps in care and ensure smooth provision of high-quality emergency assistance to geriatric clients.
The goal of the proposed project is to improve the quality and accessibility of the nursing care provided to geriatric patients in EDs. More specifically, the aim of the project is to evaluate the feasibility of replacing ED physicians with adult-gerontology nurse practitioners to provide emergency care to elderly clients. It is expected that an adult-gerontology nurse practitioner working in an ED will be better positioned to streamline the delivery of holistic care to geriatric patients.
The following PICOT question will need to be answered: “In patients 65 years of age or older (P), how does employing an adult Gerontology Nurse Practitioner in an emergency department (I) compared to an emergency department physician(C) influence their health outcomes and readmission (O) after the emergency department visit (T)?” In other words, the project is intended to compare the quality of care provided by an adult Gerontology Nurse Practitioner to the care delivered by an ED physician. The selected issue will have far-reaching implications for the cost and outcomes of geriatric care.
The costs of healthcare in the U.S. continue to escalate, as more seniors seek emergency nursing assistance across hospital facilities. The growing demand for these services is further supplemented by the unprecedented complexity of the testing and diagnostic procedures required for this group of patients (Hwang et al., 2013). Adult gerontology nurse practitioners can be better positioned than ED physicians to identify the needs of elderly clients and organize the care process in ways that minimize its costs and enhance health outcomes. For instance, they may avoid ordering unnecessary tests. Likewise, these specialists may have the education and training needed to speed up the provision of quality care, thus reducing the risks of complications and hospital readmissions in the future.
Overall, new models of care have the potential to improve the quality of nursing assistance provided to geriatric patients in emergency departments. They can also optimize the costs of such care while ensuring better health outcomes for elderly clients. More research is needed to see if an adult-gerontology nurse practitioner can provide better services to geriatric patients admitted to EDs, as compared with ED physicians.
