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Fundació de Gestió Sanitària Hospital de la Santa Creu i Sant Pau recognized as Gold winner for the Mastercard Excellence Award for Quality and Patient Safety at the 2023 IHF Awards
Emergency department plan for urgent care of frail patients: Elder-friendly area, 5-year experience
Urgent care is at the core for patients who are frail and old. This comes at a time when an aging society means more old and frail patients. Emergency department (ED) visits from this part of the population grow amid chronic diseases, undesired loneliness, poverty and climate crisis are factors contributing to an increase in ED visits. Thus, an increase in urgent care is reflected throughout Europe. Hospitals are challenged as to how to provide efficient, quality and safe urgent care as demand increases rapidly for all age groups, but especially the elderly.
International guidelines indicate that emergency care in older persons has particular risks and should be customized to be safe and quality. Against this backdrop, the Hospital de la Santa Creu i Sant Pau (HSCSP) developed a programme to provide safer and high-quality emergency care for the elderly between 2011 to 2017. This entailed designing and introducing a tailored triage procedure, an ED comprehensive geriatric assessment, a customized nurse care plan, and a pharmacist-led review plan. The main objectives of the program include the geriatrization of the ED, which entailed a cultural change in the staff. This also meant working towards a comprehensive geriatric assessment implementation. The hospital aimed to reduce the waiting time, the length of stay in ED, hospital admissions rate, adverse events, and improve the patient and family experience.
ED staff are trained for urgent care, time-dependent and life-threatening processes, and are less skilled in chronic and geriatric care. With this, another goal was to foster an elder-friendly area inside the ED that will contribute to risk prevention and performance of new geriatric procedures. New procedures, training and, most importantly, a profound change in the staff’s culture was needed.
HSCSP likewise formed collaborative networks with other healthcare providers to help bring the right care in the right place for the elderly. They strengthened their regional alliances and thoroughly systematized referral criteria and procedures with different healthcare suppliers. Finally, they set up an ED leadership team and a dashboard for process control and improvement. Resource availability improved, supported by partnerships built.
Based on data, hospitalization decreased 1.53 percentage points and referrals rose by 3.63. General ED discharges of the elder frailty area increased 51.8% since 2018, while patients returning home inched higher to 41.7% from 22.6%.
Leading the change for better patient experience
HSCSP’s efforts were acknowledged in the healthcare industry. The Catalan Health Service (CatSalut) recognized this workflow as an efficient, flexible system that is able to adapt to the demand of the ED. Other similar areas in Barcelona have since been trying to adopt the same method as encouraged by CatSalut. More than 20 centers in Catalonia paid their visits from 2021 to 2022, aiming to promote similar strategies.
HSCSP has been among the firsts, alongside institutions in the US and Canada to obtain the Geriatric Emergency Department Accreditation Program. Its steps have been followed by three more hospitals in Spain that have eventually adopted the initiative and likewise obtained the accreditation. Because of its focus in improving the provision of geriatric emergency care, it obtained European and direct funds from Catsalut to build a Comprehensive Urgent Care Clinic for Older Adults (Q-Care) in Catalan. This will be a new healthcare area spanning an extensive 5,000 square metres. It will be dedicated to a space redesign to minimize risks and optimize comfort for patients. The new facility is expected to be inaugurated by March 2026.
Find out more about Fundació de Gestió Sanitària Hospital de la Santa Creu i Sant Pau
The Hospital de la Santa Creu i Sant Pau (HSCSP) is a teaching and highly complex hospital which dates back six centuries, in
Barcelona. The centre is a recognized leader in clinical care, education and research. In HSCSP over 35,500 inpatients are
treated each year and some 160,000 emergencies.