Age Friendly Emergency Department (AFED) at Zuckerberg San Francisco General Hospital

Zuckerberg San Francisco General Hospital

The Age-Friendly Emergency Department (AFED) at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) is an American College of Emergency Physicians (ACEP)-accredited Geriatric Emergency Department (GED). GEDs have specific protocols, resources, and specialized care areas to optimize the acute care of older adults.

ACEP's GED Accreditation Program offers three levels of accreditation. Each requires GEDs to demonstrate that they have instituted certain staffing requirements, care processes, workflows, resources and/or physical environment enhancements to improve the care of older adults. ZSFG's AFED currently holds a Level 3 (Bronze) accreditation and has applied for Level 2 (Silver) accreditation.

Bronze — Level 3

For its Level 3 accreditation, the AFED at ZSFG implemented:

Frailty screening for patients over age 65 using the Identification of Seniors at Risk (ISAR) screening tool.
Interventions to:
- Adequately maintain hydration and nutrition status
- Minimize the use of restraints and indwelling urinary catheters

For its Level 2 accreditation application, it instituted:

A delirium screening protocol
A guideline for safe pain control
An intervention to sustain or increase mobility in older adults, including physical therapy consultation
The Purple Bracelet Project to address the communication needs of patients with dementia
Distinct protocols for:
- Structured cognitive impairment screening
- Phone follow-up after discharge
- Hip fracture
- Screening for nutritional status and food insecurity
Processes for
- Accessing consultations on palliative care
- Preventing and decreasing the impact of delirium
- Volunteers to work with older adults

In 2023, the AFED received the UCSF Program for Interprofessional Practice and Education's (PIPE's) Interprofessional Collaboration Award. This award, given in partnership with UCSF Health, recognizes exemplary interprofessional teams.

Mission

The Age Friendly Emergency Department (AFED) at Zuckerberg San Francisco General is committed to providing holistic emergency care tailored to the unique needs of older adults. Our goal is to improve patient outcomes and enhance quality of life following discharge by integrating high-quality, inter-disciplinary medical care with enhanced follow-up and access to community resources. We strive to empower our patients and their families through a supportive, age-friendly environment that prioritizes health, dignity, and satisfaction.

Vision

Our vision is to pioneer a transformative care model in emergency medicine that addresses the full spectrum of needs for older adults and their caregivers. By prioritizing proactive, patient-centered interventions and enhanced support, we aim to set new standards in age-friendly care, particularly for those with cognitive challenges or functional impairments. We aspire to lead the way in innovative, compassionate emergency care, ensuring every older adult receives the tailored support they deserve during and after their emergency visit.

Values

Our values include:

Age-Friendly Care: Adapting environments and treatments to respect and meet the needs of older adults
Optimized Independence: Empowering patients to maintain autonomy and manage their health effectively
Patient Values: Prioritizing the preferences and values of our patients in their care plans
Sensitivity to Diversity: Embracing the varied backgrounds and unique life experiences of our patients and their families
Caregiver Support: Recognizing and reinforcing the vital role of caregivers

Services

We:

Offer specialized care focusing on needs of older adults to optimize the emergency department experience and avoid hospitalization, when possible
Provide safe discharge plans created specifically for older adults to support them after their stay
Support and connect older adult patients to community resources and organizations, including primary care providers
Have dedicated clinical staff, including a patient navigator and a social worker

Leadership

The Age-Friendly Emergency Department (AFED) is led by:

Malini Singh

Malini Singh, MD, MBA, MPH — Vice Chief of Emergency Medicine, Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG)

Eric Isaacs, MD, FACEP — Medical Director, ZSFG AFED

Our Team

Our team also comprises experts specially trained to provide care to our older adult patients, including a geriatrician, clinical nurse specialist, nursing champion, a dedicated social worker and patient navigator, and a data analyst:

Candace Kim