Canada’s largest research hospital has received a record $52-million donation, which will be used to create the country’s first emergency department specifically designed for the health needs of older individuals.
The funding from the John and Myrna Daniels Charitable Foundation to the University Health Network in Toronto is the largest emergency medicine gift in Canadian history.
“I think it’s the most overdue needed addition to our system,” Kevin Smith, president and chief executive officer of UHN, told The Globe and Mail in an exclusive interview. “Why would we not truly design around the challenges of frail, vulnerable seniors, who are growing by the day?”
The entire design of the new Myrna Daniels Seniors Emergency Medicine Center at UHN – scheduled to open in 2025 adjacent to the existing ER at Toronto Western Hospital – will be built around the unique needs of seniors.
For instance, specialized flooring will be installed to reduce the impact of falls. The floors will be glare-resistant, and signage will be more prominent and lowered, as many older individuals have curvature in their spines that forces their gaze down. Bed rails will be lowered to make it easier to get in and out of bed. The new unit will incorporate natural light, and reduce bright lights and excessive noise, which can contribute to delirium – a devastating and often fatal condition that affects many seniors in busy, loud emergency rooms.
“There’s unique harm that is actually hospital-acquired that patients experience that we’re looking to eliminate or mitigate by incorporating design elements that are specific to this patient population,” said Sam Sabbah, UHN’s medical director of emergency medicine.
Another much-needed element at the new department will be an in-unit occupational and physical therapy suite which will simulate multiple home-like environments to help determine how or whether patients can manage on their own.
These assessments can make all the difference for seniors, Dr. Sabbah said. He recalls the case of an 85-year-old woman who came to the emergency room for a wrist fracture. She was treated and sent home, only to return a week later after a loved one checked on her and realized she hadn’t eaten in days. It turns out the woman relied on canned food for most of her nutrition and wasn’t able to open them with her injured wrist.
While the woman survived, she ended up in and out of hospital with a series of infections that reduced her independence.
“She was basically starving at home. We sent her home not realizing the impact it would have on her life,” Dr. Sabbah said. “This is one case and it stands out in my mind, but this happens daily in emergency departments all over the country.”
There are other instances when older patients come in and it’s clear they are terminally ill, surrounded by the chaotic din of life in a busy hospital. The new department will incorporate a dedicated compassionate care area where patients and their loved ones can gather to say goodbye.
“Even though we may not be able to change the ultimate outcome for the patient, the experience for that patient and their loved ones will be drastically improved.”
The new dedicated geriatric emergency department is part of a broader effort at UHN to better meet the unique needs of seniors. Since UHN is a teaching hospital and research facility, Dr. Sabbah said he hopes the best practices they are incorporating can be adopted by other centers in Canada.
For instance, instead of speaking to hard-of-hearing patients in a raised voice, which elevates noise levels throughout the department, Dr. Sabbah highlighted how a hand-held device with headphones can allow for quiet conversation that those patients can clearly understand.
“It’s a simple intervention with a huge impact. You don’t need a $52-million dollar center for that. You just need to care enough to make it happen.”