Geriatric Intervention in the Emergency Department: changes making it safer for seniors
Dr. Jed Shimizu, formerly of the Department of Geriatrics, Misericordia Community Hospital.
In collaboration with community resources and supports such as home care, geriatric outpatient clinics and outreach teams, and community seniors’ services and day programs.
Emergency department use by seniors is rising, and a large number of seniors arrive with common geriatric problems such as cognitive and/or functional decline or falls, issues that can lead to poor outcomes. If, while treating immediate concerns, the emergency department could thoroughly assess patients most at risk for poor outcomes and connect them to appropriate community resources, these seniors may be better supported in the community and have less need for institutional or emergency care. The Geriatric Evaluation Management (GEM) service at the Misericordia Hospital Emergency Department is piloting this approach
The Misericordia Hospital Emergency Department implemented a focused geriatric assessment that examined medical concerns as well as cognitive and psychosocial factors and functional ability, in the context of the patient’s living environment and level of support. Once the assessment was completed, the emergency department team referred the patient to the appropriate community supports, including geriatric outpatient clinics, geriatric consult teams such as those in Home Care and Supportive Living, and specialty geriatric services such as geriatric psychiatry or rehabilitation programs.
This innovation fund reviewed and evaluated the GEM-ED service at the MCH by conducting a quality assessment of the service through:
— Chart reviews to identify patients to track through the project
— Patient surveys
— ED staff surveys
An evaluation of the novel GEM-ED model of care.
Assessments done using the GEM-ED program are leading to better health outcomes for seniors and a reduced reliance on emergency care. The evaluation of the GEM-ED project showed that both patients and staff were happy with the service.
Patients were highly satisfied with their care and felt that the service:
1. Addressed their needs
2. Was a valuable part of their ED stay
3. Made them more aware of the resources and supports available to them
Similarly, staff surveyed understood the role of the service and felt that it:
1. Improved the attitude of staff and culture in the ED
2. Addressed the specialized, geriatric needs of patients
3. Educated staff to recognize the unique challenges in managing frail older adults
The Network is creating a toolkit from the learnings from this project and the GEM-ED service model to help spread the concepts and knowledge gained. This will hopefully help other hospitals and organizations be able to take the concepts and adapt them to their settings to help improve the care of older adults in the ED, acute care and community, resulting in improved function and quality of life.