164 Chapter 7 performing a femoral nerve block for older adults with a fractured hip is a prime example of how emergency physicians can both diagnose an injury and start effective treatment autonomously. Rapid geriatric assessment at the ED by emergency physicians would be the next expansion of the skills of the emergency physician to treat this patient group. After initial rapid geriatric assessment, emergency physicians could target frail patients likely to benefit from comprehensive evaluation in the ward by a geriatrician before advising on the need for operative treatment. Both the length of stay at the ED and patient outcomes benefit from such teamwork. Future studies should identify which older adults would benefit from independent acute treatments such as this by a well-educated and legitimately self-confident emergency physician. Especially in a critical setting such as the ED, it is important that the right care be provided by the right person at the right time and at the right place. In the ED, a department where time is relatively scarce, we could and should challenge both emergency physicians and training programs to expand their clinical skills for older adults. For geriatric emergency medicine, we should invest in protocols to not only identify and triage but also adequately treat older adults. Better trained ED staff – both physicians and nurses – will help improve the quality of geriatric treatment in the ED. This will improve patient satisfaction, reduce length of stay, and reduce ED crowding. There is no doubt about the need for geriatric emergency medicine training for emergency physician residents (41, 43-45). While this need is obvious, it is currently not implemented in the Netherlands. As long as geriatric education is not mandatory in emergency physician residency programs, emergency physicians should be educated on geriatric principles through local education programs post-residency. Our geriatric emergency medicine education program, which we developed and implemented, was positively evaluated by emergency physicians. We not only evaluated the effects of this training but also explored emergency physicians’ experiences with this program. The experiences of emergency physicians with this education program gave us insight into the preconditions for an effective geriatric education program for emergency physicians. The features of this education program – a mix of online training and (case-based) lectures – might be useful for other EDs also planning to implement a geriatric education program. Older adults usually have complex care needs: older adults suffer frommore conditions than younger patients, have less strength due to ageing andmorbidity lowering their robustness and resilience, have more (sometimes conflicting) treatment options, and have different future perspectives and needs. Now that we have a better understanding of the factors associated with an increased length of stay, we should aim to optimize these factors and help to reduce the
RkJQdWJsaXNoZXIy MjY0ODMw