A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol

Abstract

BackgroundEmergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed. The aim of this Geriatric Emergency Department Intervention is to maximise the quality of care for this vulnerable cohort in a cost effective manner.MethodsThe Geriatric Emergency Department Intervention research project consists of three interrelated studies within a program evaluation design. The research comprises of a structure, process and outcome framework to ascertain the overall utility of such a program. The first study is a pre-post comparison of the Geriatric Emergency Department Intervention in the emergency department, comparing the patient-level outcomes before and after service introduction using a quasi-experimental design with historical controls. The second study is a descriptive qualitative study of the structures and processes required for the operation of the Geriatric Emergency Department Intervention and clinician and patient satisfaction with service models. The third study is an economic evaluation of the Geriatric Emergency Department Intervention model of care.DiscussionThere is a paucity of evidence in the literature to support the implementation of nurse-led teams in emergency departments designed to target frail older persons living in the community and residential aged care facilities. This is despite the high economic and patient morbidity and mortality experienced in these vulnerable cohorts. This research project will provide guidance related to the optimal structures and processes required to implement the model of care and the associated cost related outcomes.Trial registrationAustralian New Zealand Clinical Trials Registration Number is 12615001157561. Date of registration 29 October 2015.

Nurse‐led multidisciplinary initiatives to improve outcomes and reduce hospital admissions for older adults: The Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration project

“…The GEDI nursing team is led by a clinical nurse consultant providing clinical expertise, management of the team, implementation of policy and procedure around GEDI and facilitation of the model into the ED. The responsibilities of the GEDI team include clinical expertise, collaboration, rapid assessment and management of older persons, provision of simple point of contact in the ED, provision of education for ED staff, facilitation of discharge and direct referral to inpatient and community services . Two GEDI clinical nurses are rostered to the ED on overlapping shifts from 07:00 to 17:30 Monday to Friday and one nurse 07:00 to 15:30 on weekends.…”

“…Examples of unanticipated ED re‐presentations include the following: uncontrolled pain, functional decline, or recurring symptoms related to acute or chronic disease. For those who require admission, the GEDI team provides guidance and facilitates the selection of the most appropriate admission pathway, for example direct admission to orthopaedics or gerontology .…”

Emergency department models of care in Queensland: a multisite cross-sectional study

“…31 A comprehensive evaluation of an ED-based service for all older people, whether from the community or aged care facilities, presenting to the ED is under way. 32…”

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

“…The present study, focusing on RACF residents, is a planned a priori sub‐group analysis of a larger study that evaluated the effectiveness of the GEDI models service delivery for adults aged 70 and over . A detailed methodology can be found in the study protocol and Implementation Toolkit published elsewhere . In summary, a quasi‐experimental study design was used to compare outcomes for RACF patients, aged 70 years and older, over a period of 4.8 years, in a regional ED, in Queensland, Australia.…”

“…The GEDI model is a multidisciplinary nurse‐led, physician‐championed, innovative intervention delivered in the ED by advanced practice nurses with a minimum of 5 years post registration experience and specialist expertise and/or education in gerontology who understand the unique demands of the ED environment . The primary aim of the GEDI model is to deliver high‐quality continuity of care for older adults from RACFs who present to the ED.…”