Environment

Why is this important?

Older people are major users of Emergency Departments (EDs) and tend to have longer ED stays than their younger counterparts.1-4 The ED environment can have an important influence on patient experience, but also outcomes. For example, an ED designed with the needs of older people in mind might lead to a reduction in delirium. In contrast, poorly designed EDs might lead to immobility and bedsores, falls and injuries, increased levels of delirium and functional decline – as well as increasing patient and carer ​anxiety.3-5

How can the ED Environment be improved?

There is a wealth of information available on improving design of health facilities to allow clinical areas meet the needs of older adults with sensory, physical or cognitive impairments.1-12

There are three important considerations:

  1. Physical space
  2. Equipment and human resources
  3. Staff behaviours

We have included simple changes for your existing department in “Tips: small changes for immediate impact” in the sub-headings below. For more in-depth information, see the design guidelines in the toolbox below. Many environmental recommendations can be incorporated within your ED at low or no additional cost. The most important component of a frailty-friendly Emergency Department is staff awareness of an older person’s needs.

What can you do?

  1. Physical space
    Small changes for immediate impact:
    • De-clutter;
    • Offer multiple cues for orientation to time and place, including clocks, calendars and clear wayfinding to bed spaces and toilets;
    • Transform corridors into pleasant spaces for walking about safely;
    • Ensure toilet seats and grab-rails are in contrasting colours;
    • If more resources are available, install matt flooring and good-quality lighting.
  2. Equipment & human resources
    Ensure your older patients have easy access to mobility aids, sensory aids, continence aids and nutrition and hydration. Have staff available to facilitate access to these basic needs as well as encouraging meaningful activities.
    Small changes for immediate impact:
    • Offer sensory aids - glasses, hearing aid batteries, or a magnifying glass and portable amplifying device;
    • Offer snacks and drinks;
    • Encourage social dining with companions and engagement in meaningful activity in case of prolonged ED stay.
  3. Staff behaviour
    Staff should welcome family and ensure appropriate communication. Identifying geriatric syndromes, improving mobility and helping older people maintain their function are as important as ‘traditional’ emergency care.

Toolbox

Information

This education material was developed by the European Task Force for Geriatric Emergency Medicine, which is a collaboration between the European Society for Emergency Medicine (EUSEM) and the European Geriatric Medicine Society (EuGMS). For more information, please visit: geriEMEurope.eu and follow us on Twitter: @geriEMEurope.

References

  1. Carpenter et al; Geriatric Emergency Medicine Guidelines for Staffing, Training, Protocols, Infrastructure, and Quality Improvement; Emergency Medicine reports; Volume 35, Number 21 / October 5, 2014
  2. Pascale, F, Achour, N, Price, A D F and Polverino, F (2014), Evaluation of factors and approaches affecting emergency department space planning, Facilities, 32(13/14), 761-785.
  3. Marie Boltz et al; Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues; The Gerontologist Vol. 53, No. 3, 441–453
  4. Hwang, Morrison; The Geriatric Emergency Department; JAGS 55:1873–1876, 2007
  5. Wong, Ryan, Liu; A System-Wide Analysis Using a Senior-Friendly Hospital Framework Identifies Current Practices and Opportunities for Improvement in the Care of Hospitalized Older Adults; JAGS 62:2163–2170, 2014
  6. Beckstrand et al; Emergency Nurses’ Perception of Department Design as an Obstacle to Providing End-Of-Life Care; Journal of emergency nursing; September 2012, Volume 38, issue 5
  7. ACEP Geriatric Emergency Department Guidelines 2013
  8. Yates-Bolton et al; Improving hospital environments for people with dementia: Listening event report
  9. ACEM Emergency Department Design Guidelines G15 (last updated 2014)
  10. Supporting People with Dementia in Acute Care Learning Resource NHS Education for Scotland 2016
  11. The king’s fund; Developing Supportive Design for People with Dementia The King’s Fund’s Enhancing the Healing Environment Programme 2009-2012
  12. DOH UK; Health Building Note 08-02 Dementia-friendly Health and Social Care Environments; 2015

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