Geriatric Emergency Department Initiative (GEDI) Team: An Innovative Force in Emergency Care

S96 AGS 2016 Annual Meeting

B31

Geriatric Emergency Department Initiative (GEDI) Team: An Innovative Force in Emergency Care

D. Dobschuetz. Emergency Medicine, Northwestern University, Chicago, IL.

Supported By: none

Body

There is an exponentially growing need to provide senior sensitive care in t emergency departments (ED). On a national level, patients 65 years and older comprise an ever increasing percentage of all hospital admissions from the ED. Over the last three years, in an urban University Hospital emergency department, a GEDI Team of specially trained nurses in geriatric assessments has had a profound impact. Admissions have been avoided, Length of Stays (LOS) has decreased, patients have transitioned safely, and staff attitudes have improved. These measures are the keystones of an initiative to address the needs of seniors admitted to the ED in a systematic and evidence-based way.

Method

Four ED nurses were trained to use 6 specific geriatric assessment tools and act as “geriatric liaisons” as part of the GEDI Team. The entire staff was trained to identify seniors that needed a referral to the “liaisons.” All of the assessment tools were imbedded templates in the electronic medical record. An objective staff survey was used to identify perception, care, and knowledge of ED personnel over a period of 3 years and then compared to national norms.

Results

Prior to the program implementation approximately 60% of the geriatric patients being seen annually at the ED were either full admission or observational status. During the first year there was a 16% drop in the geriatric population admission rate (44% - 25% full admission and 19% observational). This reduced rate has remained consistent over the entire course of the program. Approximately 5% of the geriatric population admitted to the ED receives referrals to the GEDI Team and/or complementary social work and physical therapy. The results show in comparison to control groups that the referred patients have higher rates of discharge (50% vs. 30%), lower admission rates from the ED (28% vs. 48%), and patients admitted to in-patient or observation, had shorter hospital LOS (88 vs.104 hours). The staff survey showed a significant improvement in attitudes, perceptions and care actions. These successful outcomes resulted in continued program funding by the hospital after grant completion.

Conclusions

GEDI Team program has implications for lowering unnecessary admissions, shorter lengths of stay, safer transitions, and improved staff attitude, perceptions and care actions. This program, because of its easy adaptability, has implications for successful replication in other EDs.

http://onlinelibrary.wiley.com.ezp.uod.edu.sa/doi/10.1111/jgs.14231/pdf