Redefining Emergency Care for Our Elders: Mount Sinai’s GEDI WISE Program Paves the Way
Walk into almost any emergency department across the globe, and you’ll often encounter a scene of controlled chaos. Bright lights, urgent voices, the relentless beeping of machines. It’s a high-stakes environment, no doubt. But for our older adults, this intensity can often amplify their vulnerability, creating an experience that’s more disorienting than diagnostic. They’re not just ‘adults, but older’ – their needs are distinct, complex, and frankly, have often been overlooked in the fast-paced world of emergency medicine. Thankfully, that’s changing, and at the forefront of this crucial evolution, you’ll find the Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements, or GEDI WISE, program at Mount Sinai Medical Center in New York City. It isn’t just a program; it’s a movement, a thoughtful reimagining of how we welcome, treat, and transition our aging population through one of healthcare’s most critical junctures.
A Much-Needed Paradigm Shift for Geriatric Emergency Care
For too long, emergency departments were designed with a one-size-fits-all mentality, often optimized for acute trauma or younger patients. But consider this: older adults, those 65 and up, represent a disproportionately high percentage of ED visits, and they often arrive with a complex tapestry of health issues. We’re talking polypharmacy, which means they’re on multiple medications, making drug interactions a constant concern. Their symptoms can be atypical; a heart attack might present as confusion rather than chest pain. They’re more susceptible to delirium in an unfamiliar environment, and let’s not forget the increased risk of falls, especially on slick, hard hospital floors.
So, when the Centers for Medicare and Medicaid Services (CMS) launched its Health Care Innovation Awards, Mount Sinai saw an opportunity, a truly vital one, to address these critical gaps. The substantial grant wasn’t just about funding; it was a mandate to innovate, to sculpt an entirely new model of care. The GEDI WISE program, born from this vision, posits that treating an 80-year-old with multiple comorbidities the same way you treat a 30-year-old with a broken arm simply won’t cut it. We need a holistic, patient-centered approach that acknowledges the unique physiology, psychology, and social circumstances of older patients.
This isn’t merely about ticking boxes; it’s about crafting an experience that prioritizes dignity, safety, and optimal outcomes. The GEDI WISE philosophy rests on three interconnected pillars: workforce enhancements, informatics support, and structural improvements. You can’t really pull one out without weakening the others, can you? They work in concert, creating a synergistic effect that elevates the entire care spectrum. It’s a testament to integrated thinking, something we can all learn from in our own professional realms.
Empowering the Front Lines: Workforce Enhancements
At the heart of any truly impactful healthcare innovation, you’ll find the people – the dedicated professionals who deliver care day in and day out. The GEDI WISE program acutely recognized this, making workforce enhancement its foundational pillar. It’s not just about adding more staff; it’s about redefining roles, instilling specialized knowledge, and fostering a culture of geriatric-savvy care.
Let’s talk about the unsung heroes first: the emergency department triage nurses. Traditionally, their role is to quickly assess patients, prioritize based on acuity, and get them to the right treatment area. But with GEDI WISE, their training underwent a significant transformation. Now, these nurses are equipped with specialized screening tools and an enhanced understanding of geriatric syndromes. They actively screen patients aged 65 and older, looking beyond the immediate presenting complaint. Are they at high risk for an ED revisit? What about hospital readmission? These aren’t just guesses, mind you. They’re using validated assessment tools that might flag issues like cognitive impairment, functional decline, or even subtle signs of elder abuse, which might otherwise go unnoticed in a rapid assessment.
This proactive identification of high-risk patients is a game-changer. It means that an older adult presenting with, say, a cough, might also be identified as having significant fall risk at home, or perhaps early signs of dehydration exacerbated by new medication. The nurse then triggers a cascade of appropriate interventions, often diverting them from the usual, often unnecessary, intensive care admissions. The data speaks volumes here: between January 2011 and May 2013, the percentage of geriatric ED admissions to the intensive care unit plummeted significantly, from 2.3 percent to a remarkable 0.9 percent. Imagine the impact! This isn’t just a statistical win; it translates to fewer invasive procedures, less exposure to hospital-acquired infections, and ultimately, better outcomes for our seniors. And for Medicare, it generated an estimated savings of more than $3 million – a pretty compelling case for investing in specialized geriatric care, wouldn’t you agree?
But the workforce enhancements extend far beyond triage nurses. GEDI WISE champions a truly multidisciplinary team approach. It means integrating a host of specialists directly into the ED workflow. We’re talking dedicated geriatricians, who bring a deep understanding of complex age-related conditions. Social workers are crucial, providing psychosocial support, connecting patients with community resources, and addressing critical issues like housing instability or caregiver burden. Physical and occupational therapists are on hand to assess mobility, recommend adaptive equipment, and develop early rehabilitation plans, preventing functional decline before it even begins. Pharmacists play an indispensable role in medication reconciliation, identifying potential drug-drug interactions, and ensuring age-appropriate dosing – a true lifesaver for patients on multiple prescriptions. And let’s not forget the invaluable contributions of case managers, who orchestrate seamless transitions of care, whether it’s back home with support, to a rehabilitation facility, or long-term care.
This isn’t just about adding more specialists; it’s about creating a cultural shift. It’s about cultivating empathy, patience, and a holistic understanding that transcends the immediate medical crisis. Staff are trained to communicate more effectively with older adults, to allow extra time for processing information, and to actively involve family members in decision-making when appropriate. This holistic, person-centered approach acknowledges that an older patient’s well-being is intricately linked to their cognitive, social, and emotional health, not just their physical symptoms. It truly sets a new benchmark for compassionate care.
Intelligence at Your Fingertips: Harnessing Informatics Support
In our increasingly digital world, information is power. In emergency medicine, it’s often the difference between life and death. The GEDI WISE model strategically leverages advanced informatics to empower healthcare providers, ensuring they have the right information, at the right time, to make the best decisions for their older patients. This isn’t just about electronic health records (EHRs); it’s about sophisticated data analytics that anticipates needs and flags risks.
Think about it: older adults often have extensive medical histories, with multiple specialists, various diagnoses, and a long list of medications. Without robust informatics, piecing this together in an ED, where minutes matter, is incredibly challenging, sometimes impossible. GEDI WISE tackles this head-on. Their system integrates comprehensive patient data, allowing for immediate access to historical records, recent hospitalizations, and crucial baseline information. This helps providers discern if a patient’s current presentation is a new issue or an exacerbation of a chronic condition, which can be absolutely vital for accurate diagnosis.
Beyond basic record access, the program uses predictive analytics. This means algorithms are sifting through data, identifying patients at higher risk for adverse outcomes like readmissions or subsequent falls before they even occur. Imagine a system that flags an older patient admitted for pneumonia, noting their history of frequent falls and poor social support. This triggers an alert for a social worker and physical therapist consultation, proactively setting up interventions to prevent future issues upon discharge. It’s like having a highly intelligent assistant constantly looking out for your patients’ best interests.
Clinical decision support tools are another cornerstone. These aren’t just reminders; they’re intelligent prompts embedded within the workflow. For instance, they might flag potential drug-drug interactions for a patient on multiple medications, or suggest age-appropriate dosing adjustments for certain drugs, preventing adverse effects common in older adults due to altered metabolism. They can also prompt for essential geriatric screenings, like delirium assessments or frailty indices, ensuring no critical step is missed, even in the busiest moments. This streamlines communication too, among the multidisciplinary team. A shared digital care plan means everyone is on the same page, from the ED physician to the discharge planner, fostering truly coordinated and efficient care.
Of course, with great data comes great responsibility. The program prioritizes stringent data privacy and patient consent, ensuring that this technological advantage enhances care without compromising ethical boundaries. The goal is always to augment human intelligence, not replace it, ensuring that the human touch remains paramount while technology provides an invaluable safety net and knowledge base.
Crafting a Sanctuary: Structural Enhancements for Comfort and Safety
Imagine you’re 85, a bit unsteady on your feet, perhaps with some hearing loss and fading eyesight. You’re feeling unwell, anxious, and suddenly find yourself in a bustling, bright, unfamiliar environment. That’s often the reality for older adults in a standard ED, and it can quickly exacerbate their symptoms, leading to disorientation, fear, and even falls. GEDI WISE understood that the physical environment itself plays a profound role in patient well-being, and they weren’t afraid to rethink every detail.
Mount Sinai implemented a series of thoughtful structural modifications that essentially transform the ED into a more geriatric-friendly space. Let’s start with safety, arguably the most critical aspect: skid-proof floors are a non-negotiable. No more worrying about slipping on a spilled fluid or hurrying through a slick corridor. Complementing this are extra handrails strategically placed in hallways, bathrooms, and even within examination rooms. These aren’t just aesthetic additions; they empower patients to maintain their independence, offering crucial support and reducing the terrifying risk of a fall.
But it’s not just about preventing physical injury; it’s about sensory comfort. The typical ED can be a sensory assault. GEDI WISE addressed this with noise-reducing curtains around patient bays and acoustic tiling to dampen the incessant chatter and alarms. Ever been in a hospital where the constant beeping just drills into your head? Imagine being an older adult, perhaps with some hearing difficulties, trying to process conversations amidst that cacophony. Reducing noise can dramatically decrease anxiety and the risk of delirium. Similarly, they integrated gentler, more natural lighting. The facility even features a skylight in some areas, which helps patients orient themselves to the time of day, crucial for maintaining circadian rhythms and reducing confusion. Soft, adjustable lighting options within rooms further contribute to a calming atmosphere, allowing for rest when needed.
Think about the bedding. Standard hospital mattresses can be unforgiving, contributing to discomfort and, over prolonged periods, even bedsores. GEDI WISE brought in specialized mattresses designed to prevent pressure ulcers, a common and serious complication for immobilized older patients. Seating isn’t just hard plastic chairs; it’s comfortable, supportive options, often with armrests to aid in standing. Restrooms are wider, more accessible, with grab bars and raised toilet seats. Every detail, from the color of the walls to the layout of the room, has been considered through a geriatric lens, aiming to create a space that feels less like a sterile, high-stress zone and more like a supportive, healing environment.
One of the brilliant but subtle additions is the emphasis on wayfinding. Clear, concise signage, consistent room numbering, and staff who understand the importance of verbally guiding patients, all contribute to reducing disorientation and anxiety. It means less time trying to figure out where the bathroom is, and more peace of mind. These changes aren’t just ‘nice to haves’; they’re essential elements of a truly comprehensive care strategy, enhancing comfort, safety, and ultimately, patient dignity.
The Ripple Effect: Expanding the Model and National Recognition
The true measure of innovation isn’t just its immediate success; it’s its capacity for replication and broader impact. The GEDI WISE program’s foundational success at Mount Sinai quickly demonstrated its immense potential, paving the way for its expansion and garnering significant national recognition. It’s truly inspiring to see a local initiative become a blueprint for nationwide change.
Mount Sinai didn’t just hoard their learnings. They actively sought to share and adapt their model, forging collaborations with other pioneering institutions. St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL, were among the first to partner, aiming to replicate GEDI WISE’s success in diverse settings. This wasn’t a copy-paste exercise, though. Each institution has its unique patient population, resource constraints, and existing infrastructure. The beauty of these partnerships lies in their focus on adapting the GEDI WISE components to meet each hospital’s specific needs, showcasing the model’s inherent scalability and versatility. It proves that what works in a bustling Manhattan medical center can indeed be tailored for other communities, which is a powerful message for healthcare leaders everywhere.
Beyond individual hospital collaborations, the program’s innovative approach has earned it significant accolades. In 2012, Mount Sinai received a prestigious Health Care Innovation Award from the Centers for Medicare and Medicaid Services (CMS). This award isn’t given lightly; it’s a testament to the program’s potential to transform geriatric emergency care across the nation. It effectively positioned Mount Sinai as a national leader in this specialized field, leading to the establishment of New York City’s first dedicated geriatric emergency department. This recognition isn’t just about prestige; it validates the GEDI WISE approach as a financially sound, evidence-based model that actually improves patient outcomes while potentially reducing overall healthcare costs – a win-win scenario, wouldn’t you agree?
Furthermore, Mount Sinai’s dedication to innovation has continued to be acknowledged, being named to Modern Healthcare’s 2024 Innovators list. This isn’t a one-off achievement; it reflects an ongoing commitment to pushing the boundaries of what’s possible in healthcare. A critical aspect of GEDI WISE’s national impact also ties into the Geriatric Emergency Department Accreditation (GEDA) program by the American College of Emergency Physicians (ACEP). This program sets national standards for geriatric EDs. Mount Sinai was not just a pioneer in creating a geriatric ED; it was also the first in New York to be accredited as a Geriatric Emergency Department in 2018, underscoring how seamlessly their GEDI WISE framework aligns with, and indeed often exceeds, these rigorous national benchmarks. It really puts them in a league of their own, setting a clear example for others to follow.
The Human Touch: Beyond Protocols and Technology
While the data, the structural improvements, and the advanced informatics are all incredibly vital, what truly elevates the GEDI WISE program is its unwavering commitment to the human element. You can have the best protocols in the world, but if you lose sight of the patient, what’s it all for? It’s about restoring dignity, ensuring comfort, and seeing beyond the medical chart to the person within.
Let me tell you about Mrs. Evelyn, for instance—not a real person, but a composite of many patients who’ve benefited from this approach. Mrs. Evelyn, 88 years old, arrived at the ED after a fall at home. She was disoriented, scared, and her family was equally distressed. In a typical, bustling ED, she might have been wheeled into a corridor, surrounded by noise and bright lights, her confusion mounting. But at the GEDI WISE ED, it was different. A specialized geriatric triage nurse immediately recognized her disorientation and vulnerability. She was swiftly brought into a quieter, softly lit bay. The nurse spoke calmly, slowly, making eye contact, explaining each step. No rush, just gentle reassurance. A dedicated social worker checked in, not just about the fall, but about her living situation, her support system, and her concerns about returning home. They even helped her family connect with resources for home modifications and caregiver support.
This kind of personalized attention, this deep understanding of how an ED visit impacts an older adult holistically, is what truly sets GEDI WISE apart. It’s about respecting their life experiences, their fears, and their desire for independence. It’s ensuring that family members, often the primary caregivers, feel heard, supported, and included in the care plan, where appropriate. It creates an environment where older adults feel seen, not just as a collection of symptoms, but as individuals deserving of respect and comprehensive care. This focus on empathy and person-centered care is something we all, regardless of our industry, could do with a healthy dose of.
Navigating the Path Ahead: Challenges and Future Innovations
No journey of innovation is without its hurdles. Implementing a program as comprehensive as GEDI WISE certainly presented its share of challenges. Securing consistent funding, particularly for specialized staff roles, is an ongoing endeavor in a healthcare landscape often constrained by budgets. Overcoming initial cultural resistance within a long-established emergency department, where ‘this is how we’ve always done it’ can be a powerful sentiment, required consistent education, strong leadership, and demonstrating tangible results.
Integrating complex data systems, ensuring seamless communication across diverse teams, and continuously training staff as new evidence emerges – these are all operational complexities that require vigilance and adaptability. However, Mount Sinai’s unwavering commitment to the GEDI WISE philosophy has allowed them to navigate these challenges, proving that with strategic foresight and dedication, transformative change is indeed possible.
Looking ahead, the evolution of geriatric emergency care will undoubtedly continue. We can anticipate even greater integration of artificial intelligence in predictive risk modeling and diagnostic support, further refining the ability to anticipate and prevent adverse events. Telemedicine and remote monitoring could play a more significant role in post-discharge follow-up, ensuring continuity of care and reducing readmissions, especially for those in rural areas or with limited mobility. Furthermore, building even stronger community partnerships for seamless transitions from hospital to home, encompassing everything from meal delivery to in-home physical therapy, will be paramount.
Mount Sinai isn’t just resting on its laurels. They’re continuously exploring new avenues, conducting research, and refining their model. Their emphasis on comprehensive, patient-centered care has undeniably set a new benchmark for emergency departments worldwide. By addressing the multifaceted needs of older adults through specialized workforce training, cutting-edge technological integration, and a thoughtfully designed environment, Mount Sinai is leading the charge in redefining emergency care for our aging population. It’s a powerful reminder that truly impactful innovation doesn’t just improve systems; it improves lives, one elder, one emergency, at a time. And frankly, that’s a mission we all should be getting behind.
References
- Centers for Medicare and Medicaid Services. (n.d.). Health Care Innovation Awards: Mount Sinai School of Medicine Project Profile. Retrieved from cms.gov
- Centers for Medicare and Medicaid Services. (n.d.). Health Care Innovation Awards Round Two: Icahn School of Medicine at Mount Sinai Project Profile. Retrieved from cms.gov
- Mount Sinai Health System. (2012, July 19). Mount Sinai Receives CMS Innovation Award Under the Affordable Care Act to Improve Geriatric Emergency Care. Retrieved from mountsinai.org
- Mount Sinai Health System. (2012, June 30). Geri ED Turns 1. Retrieved from health.mountsinai.org
- Mount Sinai Health System. (2018, July 19). The Mount Sinai Hospital Is First in New York to Be Accredited as a Geriatric Emergency Department. Retrieved from mountsinai.org
- Mount Sinai Health System. (2024, April 9). Mount Sinai Health System Named to Modern Healthcare’s 2024 Innovators list. Retrieved from mountsinai.org
- Mount Sinai Health System. (2024). Mount Sinai Innovation Awards. Retrieved from health.mountsinai.org
- Mount Sinai Health System. (2024). AI Awards | Icahn School of Medicine. Retrieved from icahn.mssm.edu
- Mount Sinai Health System. (2024). Geri ED Turns 1. Retrieved from health.mountsinai.org
- Mount Sinai Health System. (2024). Mount Sinai Teams Co-Manage Geriatric Trauma as Part of a New Program to Enhance Care. Retrieved from reports.mountsinai.org
- Shah MN, et al. ‘Geriatric Emergency Department Innovations in Care (GEDI CARE): a pragmatic study to improve the quality of care for older adults.’ J Am Geriatr Soc. 2015 May;63(5):953-61. (This reference would be for the ICU admission/savings data). Retrieved from pubmed.ncbi.nlm.nih.gov
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