Geriatric Emergency Department Innovations: Preliminary Data for the Geriatric Nurse Liaison Model

Abstract

for the GEDI-WISE InvestigatorsOlder adults account for a large and growing segment of the emergency department (ED) population. They are often admitted to the hospital for nonurgent conditions such as dementia, impaired functional status, and gait instability. The aims of this geriatric ED innovations (GEDI) project were to develop GEDI nurse liaisons by training ED nurses in geriatric assessment and care coordination skills, describe characteristics of patients that these GEDI nurse liaisons see, and measure the admission rate of these patients. Four ED nurses participated in the GEDI training program, which consisted of 82 hours of clinical rotations in geriatrics and palliative medicine, 82 hours of didactics, and a pilot phase for refinement of the GEDI consultation process. Individuals were eligible for GEDI consultation if they had an Identification of Seniors At Risk (ISAR) score greater than 2 or at ED clinician request. GEDI consultation was available Monday through Friday from 9:00 a.m. to 8:00 p.m. An extensive database was set up to collect clinical outcomes data for all older adults in the ED before and after GEDI implementation. The liaisons underwent training from January through March 2013. From April through August 2013, 408 GEDI consultations were performed in 7,213 total older adults in the ED (5.7%, 95% confidence interval (CI) = 5.2-6.2%), 2,124 of whom were eligible for GEDI consultation (19.2%, 95% CI = 17.6-20.9%); 34.6% (95% CI = 30.1-39.3%) received social work consultation, 43.9% (95% CI = 39.1-48.7) received pharmacy consultation, and more than 90% received telephone follow-up. The admission rate for GEDI patients was 44.9% (95% CI = 40.1-49.7), compared with 60.0% (95% CI = 58.8-61.2) non-GEDI. ED nurses undergoing a 3-month training program can develop geriatric-specific assessment skills. Implementation of these skills in the ED may be associated with fewer admissions of older adults. 1 The number of older adults who visit an ED has doubled in the last decade and continues to grow rapidly. Older adults presenting to EDs are highly likely to be admitted to the hospital, much more so than their younger counterparts.1 Prevention of hospital admission saves older adults from frequently encountered adverse events, including delirium, functional status impairment, cognitive loss, and nursing home admission. [2][3][4] It is unknown how many older adults are hospitalized for reasons other than acute medical illness, such as functional decline, polypharmacy, progressive dementia, caregiver stress, and unstable living situation. These nonurgent conditions are rarely addressed during a typical ED visit because of lack of resources, patient volume, and the need for rapid turnover of care spaces. 5 The predominant management strategy of emergency physicians at the Feinberg School of Medicine to handle these important but not imminently life-threatening geriatric problems is to recommend hospital admission.The main goal of the Geriatric Emergency Department Innovations through Workforce, Inform...

Emergency Department presentation of frail older people and interventions for management: Geriatric Emergency Department Intervention

“…Evidence of the efficacy of health service interventions aimed at providing appropriate care for ageing populations is present in the literature with varying levels of success reported [9][10][11][12][13][14][15][16][17][18]. Some examples of these interventions are: improving care in RACFs via change in staffing models most often to include a Nurse Practitioner [11], interventions in EDs for presentation of older people, and outreach models from health services to the community most often provided by nurses, hospital in the home (HITH) and hospital in the nursing home (HINH).…”

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

“…In an attempt to keep frail older persons at their place of residence during an acute illness, several MOC have been designed and tested. Broadly, the different MOC are divided into those that: i) provide in-home care or outreach of services from one service to another [12, 24, 27, 28]; ii) provide prioritisation or geriatric focused care in the ED [29–32]; or iii) support or enhance primary care [28, 33]. …”

Elder-friendly emergency services in Brazil: necessary conditions for care

“…Although the experiences of other countries have found positive results with the implementation of practices by nurses, it should be pointed out that they are linked to a multidisciplinary approach and, for the most part, are inserted into care models and welfare programs geared toward the elderly (5,16,18) . Another question that did not reach consensus was related to the need of a specialized interdisciplinary team in gerontology/geriatrics to support cases of high-risk and fragile elderly people.…”

“…The experiences described by care programs have demonstrated that, through appropriate geriatric assessments, identification of risks, and support strategies in the transition of the care, it is possible to reduce the return of the elderly to the ES, avoid admissions, obtain greater satisfaction, and reduce hospital costs (5,16,(18)(19) . Therefore, these studies offer different examples that can encourage new practices in the ES together with the reality of each institution.…”

“…Most programs have a multidisciplinary approach, but the nurses stand out as the professionals who often coordinate and carry out the activities (5,16) . Still, providing the guidelines in writing at discharge as well as information about the care obtained a 100% agreement and is considered an evaluation indicator of an elder-friendly ES (10) .…”