The designation recognizes emergency departments with specialized expertise, staffing and resources for patients 65 and older, who represent about one-third of all patients treated in Cedars-Sinai’s Emergency Department each year.

“This recognition reflects our commitment to delivering exceptional, patient-centered emergency care for the older adults of our community,” said Claude Stang, RN, executive director of the Cedars-Sinai Emergency Department. “As the No. 1 Medicare provider in California, we care for thousands of older adults every year, and we are dedicated to keeping them safe and healthy.”

Accreditation reviewers cited several programs and features that distinguish Cedars-Sinai’s approach to geriatric emergency care, including the Barry and Rena Plost Senior Emergency Center within the Emergency Department.

“We try to place patients who would benefit from a quieter environment in our senior care unit, where private rooms, dim lighting and reduced noise can help minimize delirium for patients who are susceptible,” Stang said. “Those seemingly small changes can make a meaningful difference for older adults in the Emergency Department.”

Other components highlighted by reviewers included:

• A specialized geriatric nurse assessment team, trained to identify delirium, dementia, fall risk and social determinants of health.
• Integrated physical therapy and pharmacy services, including prescription medication screening, review and reconciliation.
• Senior-friendly amenities, including reserved reclining chairs in the waiting area, improved signage and lighting, handrails, and accessible bathrooms.
• Tender Loving Care volunteers, who are specially trained to provide companionship and comfort for older adult patients.
• A physician who leads ongoing education on geriatric emergency care for physicians and physician assistants.

Level 1 accreditation builds on Cedars-Sinai’s broader commitment to age-friendly care. The health system also has been named an Age-Friendly Health System Committed to Care Excellence, a recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

“Older adults often have unique medical and social needs that require a different approach to emergency care, that centers around the 4M’s (What Matters Most, Mobility, Medications and Mentation) of age-friendly care,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai. “As an Age-Friendly Health System, every member of our team plays an important role in ensuring patients receive compassionate, specialized attention from the moment they arrive through a seamless transition to the next stage of their recovery.”

The Emergency Department’s research team also has been active in advancing geriatrics research, publishing on sepsis, brain injury, cardiac biomarkers and observation care. The work helps to inform evidence-based practices that further strengthen care for older adults.

Emergency Department Expansion Underway

The accreditation comes as Cedars-Sinai continues a major expansion of its Emergency Department, an investment designed to increase capacity while supporting the specialized care needs of a growing patient population.

The project will add 16,550 square feet to the department and increase the number of care spaces from 60 to 100.

Sam Torbati, MD, chair and medical director of the Emergency Department, said the project is expected to be completed by the end of 2028.

“Smaller improvements, such as a new laboratory, are expected to open this fall,” Torbati said. “Patients will begin to see more significant changes next summer.”

The first major phase will add 15 acute care beds, eight behavioral health beds to treat patients with mental health needs, six critical care and trauma beds, and a dedicated room designed to care for critically ill children. The expansion also will include new waiting areas, an updated triage space and a redesigned patient entrance to improve capacity and the overall care experience.

“Demand for emergency care continues to grow, and we’re committed to finding new ways to improve the experience and quality of care for our patients,” Torbati said. “The expansion is a significant investment in meeting those needs.”

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In January 2020, before COVID-19 was officially declared a pandemic, Cedars-Sinai treated one of the first COVID-19 patients in the U.S. Although it was a fearful time full of unknowns, physicians and investigators also knew it was an extraordinary moment in history.

“Working with that first patient on an unknown virus was tremendous,” said Jonathan Grein, MD, director of Hospital Epidemiology. “There was so much to learn. I remember wondering when I might develop symptoms and sleeping in the garage to avoid exposing others. When the first COVID-19 vaccine arrived later that year, we all paused to reflect on the effort and science that went into developing it. It was a remarkable time.”

But getting there was months in the making. Early on, a special Cedars-Sinai task force was meeting multiple times every day, strategizing about how to increase the hospital’s critical care capacity.

Michael Nurok, MB, ChB, PhD, now co-chair of the Department of Anesthesiology, was on the task force as director of the Cardiac Surgery Intensive Care Unit.

“We were seeing the news out of Italy about the surge in patients with COVID-19, and we were asked to prepare for 1,000 critically ill patients on ventilators,” Nurok said. “We had to think about how we might use ventilators for multiple patients. Luckily, we never had to do that, but we had to prepare for the worst.”

Standout Memories

There was fear among patients, loved ones and providers alike, physicians said.

“Fear about not being able to manage all our patients, fear of running out of supplies, fear of colleagues getting sick, fear of my family or me getting sick,” said pulmonologist Isabel Pedraza, MD, director of the Medical Intensive Care Unit and a member of the hospital’s Special Pathogens Response Team.

In addition, hospitalized patients were isolated. Rabbi Jason Weiner, PhD, BCC senior rabbi and director of the Spiritual Care Department, said the situation reminded him of the importance of human connection.

“The lockdown happened around Easter and Passover,” Weiner said. “We made signs for the glass doors of the Intensive Care Unit, wishing patients happy holidays. Later they told us it was grounding to know what was happening in the outside world.”

In the beginning, the number of infected patients was overwhelming, said Peachy Hain, MSN, RN, executive director of Nursing, Surgical Services and Clinical Support Programs.

“We were running out of beds and low on supplies,” she said. “But nurses are resilient, adaptable and supportive. We acted quickly to convert recovery rooms into shared spaces. We made sure every mask, gown and piece of equipment lasted. It reinforced how creative and innovative we are, and, in the end, it made nurses closer. We are one team, one family.”

For Sam Torbati, MD, medical director of the Ruth and Harry Roman Emergency Department, the early days were marked by a constant reminder there was no script for how to handle a pandemic.

“We’re prepared for any situation, but COVID-19 didn’t come with a playbook,” Torbati said. “So, every day we were in battle mode and every day, at every level, we came with a strategy, a plan, and strong communication and team support.”

Lessons Learned

Rita Shane, PharmD, vice president and chief pharmacy officer, recalled various lessons learned in the wake of the pandemic; among them, using protocols developed during COVID-19 for other emergency situations. For example, last September, after Hurricane Helene damaged a manufacturing facility and severely limited the national supply of IV bags and fluids, Shane’s team used pandemic learnings to help manage the shortage.

“COVID-19 taught us we can more efficiently respond to any emergency going forward,” Shane said. “Our real-time response time is more accelerated, and our experts can navigate any situation.”

Shane also recalled that Cedars-Sinai was one of the first hospitals to get the COVID-19 vaccine in December 2020—another opportunity to navigate a new situation.

“We needed a specific storage plan, and we needed a rollout plan since we were one of the local sites coordinating public vaccination,” she said.

Pedraza called the rapid development of the vaccine “an incredible breakthrough that likely will be one of the top achievements of our time. Prior to this, it could take as long as a decade for a new vaccine. The COVID vaccine gave us hope that there was an end to the pandemic. I hope we don’t forget the power of vaccines to stop human suffering.”

Equally rapid and transformative was COVID-19 research, said Susan Cheng, MD, MMSc, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Department of Cardiology in the Smidt Heart Institute.

“We pivoted to focus on understanding how the virus affected people differently, as well as mitigation and prevention, and later, vaccine response,” said Cheng, a professor of Cardiology. “People in every corner of Cedars-Sinai helped us in what was the most fast-paced clinical research study I’ve ever been a part of. We learned how quickly research can answer impactful questions, and I hope our findings inform future policy and clinical practice. It was a testament to how people can stretch above and beyond to improve and protect the health of humanity.”

A Medical Landscape Altered

Grein, director of Hospital Epidemiology and head of the medical center’s Special Pathogens Response Team, said the pandemic gave him a glimpse into the future of healthcare.

“Medicine can be very conservative, and it often takes years for new guidelines to come out and change clinical practice,” he said. “COVID taught us how to more quickly respond to emerging science and adapt protocols to benefit patients and staff.”

Torbati, associate professor and co-chair of the Department of Emergency Medicine, agreed.

“We rapidly readjusted safety protocols during the pandemic, determined how to isolate patients, built treatment tents and created safe environments with adequate ventilation,” Torbati said. “We had to figure out how to do things differently while also responding to heart attacks, strokes, car accidents and other common Emergency Department situations. If a similar situation happens again, we’re very prepared.”

COVID-19 changed healthcare in many ways, Hain said, such as an increasing use of telehealth visits.

“We also use home health more effectively now, which frees up beds in the hospital for patients with more immediate needs,” she said. “We also expanded our mental health programs for staff. And we expanded community resources and outreach to improve care among Black, Hispanic and Asian patients, who faced the highest COVID death rates.”

Lasting Takeaways

David Marshall, JD, DNP, RN, senior vice president, chief nursing executive and chair of the Department of Nursing, offered three pandemic takeaways that he still relies upon daily.

“It’s critical to protect health providers so they can take care of the community, and as providers, we must pace ourselves and protect ourselves,” he said.

But heavy emotions still surface when he remembers the distress of COVID-19.

“A patient’s family shared with me that they watched on their iPhone during the lockdown and isolation as their loved one passed away while a nurse held their hand and stroked their brow,” he said. “There were moments of tragedy. There were moments of fear. There were moments of joy. COVID-19 was a moment when our institution shined while we took care of our community … and while we took care of each other.”

Read more on the Cedars-Sinai Blog: New COVID-19 Vaccines Hit the Market  

Untreated heat exhaustion can lead to heatstroke, a life-threatening condition that can cause confusion, seizures and loss of consciousness.

Yang told ABC 7 correspondent Denise Dador that older people are especially at risk, and it’s important to check in on them when the temperature soars.

“By the time you have heatstroke, most of these people are confused and not acting normal,” he said. “Patients will start going into multi-organ failure so their livers can fail. Maybe during these times they should get family involved to watch over them.”

Yang told Dador children also should be closely monitored, as they are not able to regulate their body temperature as easily as adults. If they’re acting dizzy, if they feel nauseated or if they’re extremely sweaty, Yang said those are “probably signs that they’re heading towards heat exhaustion.”

Torbati, associate professor and co-chair of the Department of Emergency Medicine at Cedars-Sinai, told the Beverly Press/Park Labrea News that staying hydrated and avoiding exercise during the hottest part of the day is good prevention.

“We are blessed to live in Southern California, but if we spend too much time outdoors in the heat, we’re going to get sick,” said Torbati, who is the Levin/Gordon Chair in Emergency Medicine in Honor of Joel M. Geiderman, MD. “We have to limit how much time we spend outside.”

Click here to watch the entire segment on ABC 7, and click here to read the complete article from the Beverly Press/Park Labrea News.

Throughout the conference, Cedars-Sinai emergency physicians will be available for interviews about a variety of topics, including whether some groups of people experience longer wait times for emergency care and how a new definition of diagnostic excellence for emergency medicine will improve the quality of emergency care for patients.

“ACEP’s scientific assembly is the largest annual conference in emergency medicine, and it is a fantastic venue where renowned leaders in our field present high quality research that leads to practice changes and improved outcomes for patients,” said Sam Torbati, MD, co-chair of the Cedars-Sinai Emergency Medicine Department. “It is a great source of pride for the department to share research on various important topics, including disparities in care, diagnostic excellence, observation medicine, and innovations in informatics.”

Research being presented includes:

• Emergency physician Kaytlena Stillman, MD, MPH, MSHS, will discuss “Socio-Demographic Disparities in Emergency Department Wait Times” in Research Forum Exhibit Hall, Room 4 on Sept. 30 at 1 p.m.

Posters include: 

• “Defining Diagnostic Excellence for the Emergency Department Setting: Results From a Literature Review and Expert Panel Discussion” by emergency physician and Assistant Professor Carl Berdahl, MD, MS. This poster will be presented in Research Forum Exhibit Hall, Poster Session on Sept. 30 at 8 a.m. 
• “Review of the Value of Emergency Department-Run Observation Units” by emergency physician and clinical informatics expert Sri Harsha Palakurty, MD.
• “Enhancing DMV Reporting of Loss of Consciousness Events Through a Clinical Decision Support Alert in the Epic EMR System” by emergency physician and clinical informatics expert Sri Harsha Palakurty, MD.

To arrange an interview, please contact:

Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org

Sally Stewart | 310-729-4369 | sally.stewart@cshs.org

Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, said older adults can be especially sensitive to heat.

“Older adults who have chronic lung or heart conditions or diabetes can be especially vulnerable,” she said. “It’s a good idea to check in on any older adults you know. Cooling centers are open throughout L.A. County and can bring great relief in the heat.”  

Sam Torbati, MD, co-chair of the Department of Emergency Medicine at Cedars-Sinai, said,  “It’s important to stay hydrated and avoid overexertion. Once you start feeling the effects of heat exhaustion, you need to take action to cool down. Cold baths, fans, air conditioning, drinking cold water—all will help.”

Heat exhaustion occurs when the body sweats so much that it loses water and sodium. When that happens, the body can no longer regulate its temperature. Symptoms include a rapid heart rate, profuse sweating, muscle cramping, dizziness, headache and nausea. If the body temperature reaches 103 degrees, heatstroke—a medical emergency—can occur, causing confusion, seizures and loss of consciousness.

Rosen and Torbati are available for interviews.

To arrange an interview, contact: Soshea Leibler | 213-215-8000 | soshea.leibler@cshs.org

Cedars-Sinai Medical Center has embarked on a three-year Emergency Department expansion project that will enhance access and efficiency as well as enable more specialty healthcare. 

When the project is complete, it will add 16,550 square feet to the department and increase the number of care spaces from 60 to 100. 

“Unlike hospitals that are either closing or reducing their services, Cedars-Sinai is living up to its promise of meeting the community’s needs by expanding our emergency medical services,” said Sam Torbati, MD, associate professor and co-chair of the Department of Emergency Medicine and medical director of Emergency Medicine. 

“We’re not just expanding the physical space. We’re also implementing innovative care models that will allow us to serve patients efficiently, provide high-quality care and reduce wait times,” said Torbati, the Levin/Gordon Chair in Emergency Medicine in Honor of Joel M. Geiderman, MD.

Purposeful Repurposing

The first step in the expansion project is underway. The current patient drop-off section is being converted into an indoor-outdoor patient waiting/triage area that will be roofed, open on one side and equipped with air conditioning and heating. The space also will feature groupings of comfortable chairs and greenery-filled planters. The new patient drop-off area will be on Gracie Allen Drive in front of the North Tower entrance. Valet parking will be available.

“This first component of the project should be completed in a few weeks. It not only will immediately provide additional space to accommodate arriving patients and reduce crowding, but it will be a very inviting, spacious environment,” said Zeke Triana, vice president of Facilities Planning, Design, and Construction.

The new space will address a frequent complaint.

“In a time when we are still navigating communicable diseases such as COVID-19, flu and RSV, patients often voice their concerns about sitting too close to others. The physical distancing that was practiced during the pandemic is now preferred by many people, and I think this indoor-outdoor space will help them feel more comfortable and protected,” said Claude Stang, RN, executive director of the Emergency Department.

New Space—New Flows

Patients entering the new waiting area will be quickly assessed by a nurse. Patients experiencing serious medical situations will be immediately moved to a treatment room.

“The addition of the indoor-outdoor space frees up room in the main waiting area to implement more efficient workflows,” Stang said. “For example, we’ll have a phlebotomist on hand to draw blood for lab work, and we’ll be able to run EKGs before patients are even given a bed." 

Further efficiencies will result from the addition of what’s called a physician in triage who is paired with a nurse. The department already has one such team and will now have space to add a second. These triage teams will see patients with less serious issues who can be promptly diagnosed, treated and safely sent home, helping to significantly reduce wait times.

“Our patients want to come here, and we want to be there for them,” Torbati said. 

Expansion Enables Specialized Care

When the expansion is completed, new features will include:

• Critical Care Suite—Six state-of-the-art rooms designed and equipped to provide care for acutely ill adults and one room created to meet the needs of acutely ill pediatric patients
• Behavioral Health—Several beds designated for patients requiring mental health services

Torbati said the expansion will benefit staff members as well as patients.

“They’re such a dedicated, hardworking group who take care of a high volume of often complex patients," Torbati said. "The expansion will provide more resources, more space and more efficient models of care." 

Read More on the Cedars-Sinai Blog: A Little TLC Goes a Long Way to Help Older Patients