Geriatric Emergency Medicine
In 2012, The Mount Sinai Hospital opened New York City’s first emergency department (ED) dedicated to patients 65 and older. Since then, the Mount Sinai Geriatric Emergency Department has received considerable national and international attention for its vision and innovation.
We are committed to providing the additional resources needed by our aging population, which enable comprehensive evaluations and coordinated management and discharge planning. This includes a number of creative programs focused on safe transitions of care. For example, the Geriatric ED has a physical therapist to observe and instruct patients on how to avoid falls; a dedicated pharmacist reviewing all medications; and specially trained volunteers to assist patients with their needs. Due to increasing use by our community, the Geriatric ED moved into a larger space in 2015.
Each year, more than 15,000 geriatric patients seek emergency care at Mount Sinai,and as many as half arrive at the hospitals by themselves. In a busy emergency department setting, they can become disoriented, making them susceptible to falls, delirium, and other ailments unique to this population.
Our Geriatric Emergency Department features skid-proof floors and extra handrails to help prevent falls; dimmable lighting and diurnal skylights that mimic natural outdoor lighting throughout the day; and curtains designed to let in less noise. There are extra heating units to keep older patients warm; special mattresses that help prevent bedsores; and special lounge chairs that make it easier for geriatric patients to get in and out of. Some rooms also feature tablet computers that patients can use to contact the nursing station when they have a need or concern.
Our team of physicians, nurses, social workers, support staff, and volunteers are united in making elderly patients more comfortable during their time in the hospital. This holistic approach is based on Mount Sinai’s philosophy that these patients will leave with better clinical outcomes, and have a higher quality of life long-term, due to improved coordination of care. In addition, there is a training program for volunteers called CARE (Care and Respect for Elderly), who assist geriatric patients in the ED. These efforts are particularly important as the U.S. population of seniors continues to grow.
Emergency Department Palliative Care
Palliative Care is an approach to treatment focused on improving quality of life for patients living with serious illnesses as well as those at the end-of-life, with interventions designed to prevent or relieve suffering from physical, psychosocial and spiritual distress. We believe that this type of care can and should be provided within the Emergency Department, and our division works to build capacity in our providers to provide primary palliative care to our ED patients. We also partner with specialists within the health system to provide ED and inpatient consults or referrals for outpatient follow-up when indicated. Our central mission is to provide goal-concordant care that respects patients’ individual values and treatment preferences.
Education
Education is a cornerstone of our Division’s mission. We regularly teach didactic sessions for residents in both our Mount Sinai Hospital/Elmhurst and Mount Sinai Morningside-West training programs focused on symptom management, communication skills and end-of-life care. Faculty also participate in ongoing continuing medical education focused on palliative care. Recently, all full-time faculty in our training programs completed EMTalk training, a nationally-recognized course focused on building skills in serious illness communication.
Emergency Medicine is one of ten specialties whose graduates are eligible to pursue board certification in Hospice and Palliative Medicine. Several residents and faculty from our training programs have gone on to enter Hospice and Palliative Medicine fellowship. Residents who have a special interest in palliative care or who are considering applying for fellowship training are able and encouraged to complete elective rotations with our inpatient palliative medicine colleagues or with our faculty leading palliative care initiatives in the municipal health system.
Clinical Initiatives
In recent years, our Division of Emergency Geriatrics and Palliative Medicine has partnered with the Mount Sinai Health System Department of Geriatrics and Palliative Medicine on a number of clinical initiatives to improve the delivery of palliative care to ED patients. For example:
- Weekdays, a board-certified palliative care physician is available for in-person assistance with urgent symptom management, advance-care planning or goals of care discussions. Overnight and on weekends, consultation is readily available by phone. During periods of high need, such as the peak COVID-19 patient surge in March-April 2020, the health system responded by increasing availability of in-person and telemedicine support for all EDs within the system.
- Patients with comfort-focused goals who require hospital admission for symptom management are eligible for direct admission from the Emergency Department to the Mount Sinai Hospital Palliative Care Unit or an inpatient hospice bed at other sites within the system. We are continually refining protocols to identify and streamline this process to limit delays due to unnecessary transitions in care.
We developed a training program for hospital volunteers to serve as doulas for patients near the end-of-life, with the goal that no patient in our EDs should die alone. We have also established relationships with social work and chaplaincy resources at all sites to assist with legacy-making and bereavement counseling for families confronting the sudden death of a loved one in the ED