Creating a safe haven for older adults in the Emergency Department

Housed within the Emergency Department at Mount Sinai Hospital, the Geriatric Emergency Medicine (GEM) team works with older patients, their health care providers and families to determine how they can receive the best care following the emergency department visit whether in their homes, in hospital or in a rehabilitation centre. The GEM team includes specialized geriatric emergency management nurses, occupational and physical therapists, social workers and home care coordinators.

Restrictive visitor policies have made being admitted to hospital during the pandemic particularly difficult and intimidating to older patients, said Dr. Don Melady, emergency physician and Geriatric Lead of the Schwartz/Reisman Emergency Centre. Being unable to have their caregivers and usual support networks at the bedside has made the ED experience much more challenging for patients.

Instead, Melady said staff try to fill the shoes of caregivers and patient support through detailed extended assessments. The team has created what it calls the ‘gold-standard of care’ for older people by having GEM nurses who are integrated into the emergency department.

“The extended assessments succeed in getting many people home or to a rehabilitation centre who would otherwise end up languishing in hospital for a long time,” said Dr. Melady. “We have a culture of physicians and nurses in our department who are tuned into the needs of older people.”

Staff are starting to see measurable benefits. The Mount Sinai Hospital Emergency Department consistently has a lower than average admission rate for older people, compared to other hospitals in Toronto. Sinai Health currently has a 30 per cent admission rate, while the city-wide rate is 10 per cent higher.

“I have always loved caring for older people,” said Mary Ann-Hamelin, a geriatric emergency management nurse. “I love this role, because you can make a difference. We can access resources for older people they may not know about or access themselves.”

The Schwartz/Reisman Emergency Centre is open 24 hours a day, seven days a week, 365 days a year.