How a B.C. hospital uses research evidence to improve care for elderly patients

Number 6, 2006

At Burnaby Hospital, one of 12 acute care facilities in British Columbia’s Fraser Health Authority, people aged 85 and older are the fastest growing group using the emergency department. Where others might only see a challenge, management and staff at the hospital saw this growing population as an opportunity to use research evidence to improve quality of care.

“We knew we had to organize ourselves to better meet the complex health needs of seniors,” says Arden Krystal, executive director of Burnaby Hospital. “We also wanted to improve the quality of the emergency department experience for older patients and their families and, if possible, decrease the [length of the] hospital stay for those who are admitted.”

Burnaby took a two-stage approach. First, it piloted the use of a geriatric emergency nurse clinician, knowledgeable about both emergency and geriatric nursing, to assess elderly patients arriving in the emergency department. Second, it developed a workshop to train other emergency department staff — particularly nurses — in geriatric health issues.

“Seniors are a distinctly different group of patients,” explains Marcia Carr, clinical nurse specialist at Burnaby Hospital, who spearheaded the training project. “Their symptoms can be quite different and they often have several complex chronic health issues layered below the presenting acute care need.”

When seniors have a heart attack, for example, their symptoms are different from those of younger adults — rather than experiencing crushing chest pain that radiates to the jaw and down the arm, they feel something like indigestion and shortness of breath. Add an underlying condition such as dementia, and the resulting complexity makes it even more important to ensure that systems are in place to make certain care is context-sensitive and evidence-based.

The training workshops for emergency room staff have had a noticeable impact. Because of the hospital’s comprehensive approach to the problem, nurses and other emergency department staff can more quickly recognize unique behaviours and symptoms in seniors and identify underlying chronic health issues, making them better equipped to determine treatment options. “What’s also important,” says Ms. Carr, “is that staff report feeling tremendous professional and personal satisfaction in being able to provide better care for older patients.”

The training, combined with the use of a geriatric emergency nurse clinician, has had a dramatic effect, and the hospital has the data to prove it. “In four months we saved 1,170

patient-days,” reports Ms. Krystal. “We were able to reduce the [length of the] hospital stay for older patients by an average of four days, because the care plan was started right away in the emergency department. And better yet, patients and their families were more satisfied with the quality of care.”

As a result of this success, the geriatric education component of the Burnaby project is being rolled out across British Columbia through the Geriatric Emergency Network Initiative (GENI). Recognizing the potential, the B.C. Ministry of Health’s nursing directorate provided funding to further develop the training to ensure its relevance and applicability province-wide and to help roll it out. The first training workshop was held in March 2006, and more workshops are planned.

“GENI is a very timely project,” says Diane Clements, acting executive director of the provincial nursing directorate, “because it’s targeting both the emergency department crisis and our rapidly growing elderly demographic. There’s no single solution to either of these issues, but GENI will certainly have a positive impact on both.”

For more information on GENI, please contactMarcia Carr at marcia.carr@fraserhealth.ca.