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Kevin Biese, MD, said he trained for “helicopters and chest tubes” as he was wrapping up his residency about a dozen years ago. But his shifts as an emergency physician at the University of North Carolina at Chapel Hill are more likely to unfold far differently these days, with home health referrals, delirium assessments, fall-related concerns, and end-of-life treatment quandaries.
The nation’s emergency departments (EDs) operate more like a “care transitions hub,” Dr. Biese said. “We are no longer just acute accidents and injuries. But rather we’re the place you go to decide what the diagnosis is, and what the care plan is after that.”
As chair, Dr. Biese is leading the American College of Emergency Physicians’ (ACEP’s) board of governors for its geriatric ED accreditation initiative, a just-launched effort to improve and standardize emergency care of the nation’s older patients. Approximately 60% of Medicare patients who are admitted to the hospital arrived first through the ED, according to a RAND Corporation report published in 2013.1 Research published in recent years also has highlighted how older adults, defined as aged 65 years and older, frequently struggle more medically and physically after an emergency visit, even if they were never admitted to the hospital.
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