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Maggie McKay (Host): Welcome to Wise and Well, presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Today, Bret McClure, Director of Emergency Services at Community Memorial Healthcare, is here to discuss what the geriatric emergency department accreditation is and how Community Memorial attained it. Thank you so much for being here today, Bret.

Bret McClure: Thank you. Thanks for having me.

Host: Yeah. First of all, congratulations, this is a really significant achievement. Could you please start by explaining what the geriatric emergency department accreditation means and what are some of the specific changes or protocols that were implemented in the ED to meet the criteria?

Bret McClure: Yeah, sure. I do want to start out by thanking our team for this accreditation. We had physicians, nurses, techs, and especially a huge shout out to our quality department. They were all actively involved with this accreditation. But the geriatric emergency department accreditation is really about demonstrating our commitment to providing high-quality care for older adults that may come through our emergency department

Years after years, we've found that the older population, they had unique needs. They sometimes present differently. They might be on additional medications or multiple medications. And we realize that it requires a little bit more coordination across services across our entire healthcare organization.

This accreditation, we've been ensure to put the right protocols, resources, and trainings and needs to make sure that we're really meeting the needs of the geriatric population. To achieve this, like I mentioned, we did multiple changes. We've trained our emergency department nurses in geriatric-specific competencies. We've developed new protocols, which include some fall risk screening, medication safety, ways that we can decrease Foley catheter usage. We've implemented followup phone calls for our discharged patients. And really importantly, we've worked with community resources to make sure that they have the correct followup when they do leave the hospital.

Overall, this accreditation, the team works really closely together to ensure that this population really has a successful visit, a very compassionate visit, and we really tailor it towards their needs when they're here.

Host: I love the follow-up idea. It's so important, especially, I would think, that population. Because you don't know if they have someone looking out for them. But you touched on this a little bit, let's talk about the patient experience. What unique challenges do geriatric patients face in an emergency setting? And how will this new approach make a difference for them?

Bret McClure: So, our older adults, they do face unique challenges when they present to any emergency department. For example, they come in with sometimes multiple health conditions, lots of medications and all these can complicate diagnosis and treatments when you're here in the emergency department. They're also at a higher risk for issues like delirium, falls, difficulty communicating, especially if they've got hearing or vision impairments that were also tailored to their visits.

You know, on top of that, the ED can be overwhelming and stressful. There's loud noises, there's confusion. And this can all increase their anxiety when they're here within the department. So, our new approach, we've built processes and resources really to address these challenges. From the moment they walk in, our triage nurses will screen them for fall risk, cognitive changes, medication safety. Then, our team has been trained to recognize those subtle signs of illnesses that might be missed on a normal visit. We changed some of the environments within the emergency department when it comes to lighting, some of our signage. And then, we've changed kind of our discharge instructions as well, to make them tailored a little bit more towards that geriatric population a little bit easier to follow, and especially a little easier to see by changing some of the fonts that are on those discharge instructions.

Host: That makes so much sense, all those changes. So, what should a patient age 65 or older expect now when they come to our emergency room?

Bret McClure: Yeah. So, I think now, you know, 65 and older, this geriatric community, when they do come in, they should be able to expect a more personalized and attentive experience. You know, from the very beginning, like I mentioned, we start changing our screenings that we do, which really kind of set up the rest of their visit based off some of these screenings that we do.

They'll notice that our team takes a little bit of an extra step when it comes to the environment to make it more comfortable. Like I mentioned, brighter light, notable signage, warmer blankets. And there's some other tools that we help with some visual needs as well when this population comes into the ED.

Most importantly though, and I touched on this just a little bit ago, is our patients can expect that their care doesn't end when they leave the ER. We've built relationships with our primary care community resources. So, they have support for when they do go home or back to a nursing home, that we can get them in contact with some additional resources for follow up after they leave the emergency department.

Host: So, a common question for many people is when to go to the ER versus an urgent care clinic. I myself always struggle with that. I'm like, "I don't know." How can people in our community make that distinction? And what are the key differences between the services offered?

Bret McClure: I think we get this a lot coming up on, we call it, you know, flu or respiratory season. So, it's a good question. In general, urgent care clinics are a good option for those minor illnesses or injuries that might need attention but that aren't life-threatening. So, things like an ear infection, a mild asthma flare up, sprains and strains, minor cuts that might just need a few stitches. You know, the emergency department, on the other hand, is really the right place. For those serious potential life-threatening conditions, these include things like your chest pains, short of breath, stroke symptoms, severe injuries, bleeding that you can't stop, sudden change in mental status. The ER, we're built just differently than urgent care, is that we've got advanced imaging, we've got immediate lab testing, we have multiple specialists that we can reach out to. And then, we have lots of lifesaving interventions that an urgent care clinic just simply aren't equipped for. So really, you know, like I tell a lot of people when they ask me these questions, I usually say, if it's a life-threatening condition, don't wait. Come to the ER or call 911. If something's minor but still needs medical attention, maybe an urgent care might be the appropriate place to go.

Host: Good advice. Bret, for seniors and their caregivers, what are the most important things to bring with them to the emergency department to help prepare for a visit? I'm sure that that's probably a little difficult, because you're not planning on going to the emergency room. But what do you advise people to do in that situation?

Bret McClure: Yeah, yeah. It's always tough and I don't think emergency room visits are ever truly planned. But really, one of the best ways really for anybody is to come prepared, if possible, by bringing a list of their current medications, which we really include dosages, and when they were taken last. Medication safety is extremely important for older adults just because having that information upfront help us avoid delays, or some contraindications with other medications that one might be given.

So, we really encourage a current up-to-date medication list is really important. You know, it's also important to bring a list of your medical conditions or your medical history, any allergies you might have, contact information for family, your primary care or maybe another specialist. And then, advanced directive or a POLST form is always important as well. So, we can get a copy of that and then upload it into our EHR system.

Another thing that people sometimes forget is the personal items. Your glasses, your hearing aids, mobility devices, these are all just things that can really make that visit just a little bit more comfortable for that particular patient.

In addition, I encourage everybody to join myChart. This is a very user-friendly application for all patients, but it's a way that you can upload or we have access to medical records. We've got your medications, your allergies, your history, shows what visits you've had. And it's a way that our physicians can log in and really see your overall care that you've done. And anybody can join. All you have to do is just go to www.mycmh.org/mychart. And you get signed up for it. But we really encourage all patients to be part of myChart.

Host: Well, it sounds like you guys have all the bases covered, and I think this just sounds like a wonderful program, and no wonder you got the accreditation because you've really, really gone into a lot of detail to cover all the bases. So, thank you so much for telling us about it. It's been so informative and I'm sure it will be very helpful information to caregivers as well as patients.

Bret McClure: Yeah. Thank you. Thank you very much. We are also planning on in 2025 to have our Ojai campus be geriatric-accredited as well. So maybe, we'll come back on and discuss that once we get that accreditation.

Host: We love it. That is awesome. We would love to have you here again. Thank you so much. Again, that's Bret McClure. And again, if you'd like to find out more, you can go to mycmh.org/mychart. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wise and Well from Community Memorial Healthcare.