Learn, unlearn, and learn again: the secret to changing how elderly patients are attended in the emergency department

The demographic shift toward ever greater numbers of older patients with multiple conditions and functional dependency has increased pressure on emergency departments (EDs). The traditional approach to emergency treatment does not resolve problems in this population, creates risk, leads to high admission rates, and collapses the ED itself. Medical associations recommend that multidisciplinary teams incorporate geriatric assessment strategies and procure safe care enviroments. Implementing such recommendations will require profound changes in ED processes and staff and in connections between the ED and the community the patient is discharged to. This paper describes the processes we used in our tertiary-care hospital to achieve the necessary level of change. Our aims were to ensure that the ED staff provides correct diagnoses and treatments for elderly patients; bases decisions on the patients' clinical, social and functional needs and the preferences of both patient and family; and arranges for the most appropriate treatment environment in each case. All these changes were essential for properly addressing new care demands while achieving optimal patient outcomes and contributing to better ED and hospital performance.