First in the Nation: All San Diego Hospitals Now Accredited for Geriatric Emergency Care

Susan Nelson, center, with the team of Geriatric Emergency Nurse Initiative Experts (GENIEs) at UC San Diego Health. GENIEs provide patient screenings and additional care needs, all focused on transition of care with the ultimate goal of reducing hospital admissions and assisting in the discharge process, so patients can recover at home as soon as possible. Photo credit: UC San Diego Health.

Susan Nelson, a retired schoolteacher from San Diego, never thought she’d have to call 911 for herself.

“It was late at night, last November, and I was having unusual symptoms. I felt very shaky, nauseous, and I was experiencing heart palpitations. I decided to call the triage nurse line at UC San Diego Health,” Nelson said. “They advised me to call 911, which was a first for me.”

When the EMTs arrived, Nelson’s temperature was at 104.5. She was taken to the emergency department at Jacobs Medical Center at UC San Diego Health.

Nelson stayed one night in the general emergency department and was then transferred to the hospital’s Senior Emergency Care Unit (SECU) on the second night for additional observation.

Housed within the Gary and Mary West Emergency Department at Jacobs Medical Center, the SECU opened in 2019 and was California’s first unit of its kind dedicated to the emergency care of senior adults.

“Senior patients face common complications, such as being high risk for falls and cognitive challenges. In this dedicated space, we provide a much more holistic approach to medicine, following the age-friendly health system model, to ensure needs are being addressed in the patient’s preferred way,” said Dr. Vaishal Tolia, medical director of the Department of Emergency Medicine at UC San Diego Health.

Recently, San Diego became the first county in the nation where every eligible hospital has earned geriatric emergency department (GED) accreditation from the American College of Emergency Physicians (ACEP), providing senior patients access to specialized emergency care wherever they happen to live in the region.

The announcement came Aug. 11, 2022 at Jacobs Medical Center at UC San Diego Health in La Jolla. Representatives from each local health system, local and state government, the Hospital Association of San Diego and Imperial Counties, and West Health, a San Diego-based nonprofit focused on improving aging, all gathered on the hospital’s west lawn to share this exciting news with the community.

Patient room within the Gary and Mary West Senior Emergency Care Unit at Jacobs Medical Center at UC San Diego Health in La Jolla. Photo credit: UC San Diego Health.

In 2018, UC San Diego Health led this effort by becoming the first hospital system in the Western region to receive accreditation for geriatric emergency care.

“The Senior Emergency Care Unit within the Gary and Mary West Emergency Department at UC San Diego Health was a first-of-its-kind in California, with a Level 1 Gold accreditation by ACEP,” said Patty Maysent, CEO, UC San Diego Health. “UC San Diego Health is proud to have helped lead these efforts in our San Diego region and now be part of 18 hospitals accredited for geriatric emergency care, the only county in the nation to achieve this impressive goal.”

Consisting of 19 patient rooms, the SECU features architectural design elements for older patients, such as carefully calibrated lighting and improved acoustics, safety and comfort. The customized waiting room boasts chairs with high backs and sturdy arms and legs to assist seniors in sitting and standing.

Patient rooms are equipped with sound-absorbing walls and ceilings to reduce ambient noise; a variable lighting system that orients patients to the actual time of day; and contrasting colors between walls and floors and between toilet and chair seats and floors improve mobility and reduce fall risk.

“Going to the emergency room is not an everyday experience,” said Nelson. “I commend UC San Diego Health for establishing this unit and separate wing for senior care. I’ve never seen anything like it and appreciated all the small details taken into consideration in this specialized unit.”

All patients in the SECU are treated by a team with special training in geriatric medicine, including pharmacists to manage medications and social workers to ensure a smooth transition home upon discharge.

Exam room within the Gary and Mary West Senior Emergency Care Unit at Jacobs Medical Center at UC San Diego Health in La Jolla. Photo credit: UC San Diego Health.

Specifically, patients are seen by Geriatric Emergency Nurse Initiative Experts, GENIEs for short. GENIEs provide patient screenings and additional care needs, all focused on transition of care with the ultimate goal of reducing hospital admissions and assisting in the discharge process, so patients can recover at home as soon as possible.

“The value of having an accredited geriatric emergency department provides benefits for patients and their caregivers, our nurses, physicians and staff, with the ultimate goal of reducing the need for hospitalization and allowing seniors to return home sooner,” said Tolia.

After two nights, Nelson was able to go home, just in time for Thanksgiving with her loved ones.

ACEP established its Geriatric Emergency Department Accreditation Program in 2018 in response to growing evidence that emergency departments are less able to meet health care needs of older persons who often have multiple chronic conditions and social support needs. The West Health Institute and The John A. Hartford Foundation provided financial support and foundational work for the program.

The program offers three tiers of accreditation based on multiple factors, including geriatric-focused policies and protocols, clinical and patient outcomes and staff, senior-friendly physical environment enhancements and quality improvement initiatives.

The 18 accredited GEDs in San Diego are among Alvarado Hospital Medical Center, Kaiser Permanente San Diego, Palomar Health, Paradise Valley Hospital, Scripps Health, Sharp HealthCare, Tri-City Medical Center, UC San Diego Health and VA San Diego Healthcare System.

According to county officials, the GEDs have the potential to touch the lives of more than 275,000 seniors who account for roughly one-third of all emergency department visits in San Diego. In California, only about 29 percent of older adults live in a city with a GED. Nationally, that number drops by almost half, with only 15 percent of seniors living in a city with a GED.

“The staff taking care of me in the emergency department were just so over the top caring,” said Susan. “The nation will look at San Diego and see it as number one.”

The geriatric emergency departments at UC San Diego Health are part of the institution’s senior medicine program, which is among the best for geriatric care. For the 2022-2023 U.S. News & World Report, UC San Diego Health ranked 11 for Geriatrics in the nation’s top 50 programs, out of more than 4,500 hospitals nationwide.