Improving the quality of care of elderly patients in the ED: Geriatric Emergency Department intervention

Mrs Andrea Taylor1,2, Dr Elizabeth Marsden1,2, Dr Marc Broadbent2, Dr  Alison Craswell2, Professor Marianne Wallis2, Mrs  Colleen Johnston2

1Sunshine Coast Hospital and Health Service, Queensland Health, Birtinya, Australia, 2University of the Sunshine Coast, Sippy Downs, Australia

Emergency departments (ED) are experiencing an increase in the volume of elderly persons, resulting in significant challenges. Interventions within the ED targeting this vulnerable cohort are essential to improve health outcomes and reduce overall associated cost. The Geriatric Emergency Department Intervention (GEDI) is an innovative model of care, provided in a consultant capacity, focussing on early assessment of older patients to support to clinical and disposition decision making. Consequently, inappropriate and unnecessary hospital admissions are potentially avoided and early discharge is facilitated. GEDI nurses communicate with and provide support to primary and secondary healthcare sectors and residential aged care facilities.

This research used a quasi-experimental pre-post design and an embedded qualitative component to describe the structures, processes and outcomes of GEDI. Primary outcomes included disposition, length of stay in ED and hospital (if admitted) and all-cause mortality.  We used a survival analysis to jointly model length of stay and disposition, with discharge outcomes as competing risks. Health economic analysis utilised generalised linear modelling for cost outcomes.

When compared with pre-intervention, GEDI significantly reduced the risk of longer length of stay in the ED (HR = 1.29; CI 95%: 1.06 to 1.58) and increased the likelihood of discharge (HR = 1.27; CI 95%: 1.19 to 1.36) for people 70 years of age and over. We observed a cost reduction in both ED presentations ($35 [95% CI: $21, $49]) and hospital admissions ($1,469 [95% CI: $1,105, $1,834]) for the full-GEDI compared to the pre-GEDI period. The ED staff reported high levels of satisfaction with GEDI.

The GEDI model of care, embedded in the ED and focused on the vulnerable elderly population, improves patient care, reduces costs and supports ED staff management and workflow.


Biography:

Andrea Taylor is a Clinical Nurse Consultant who leads the Geriatric Emergency Department Intervention (GEDI) team of nurses at the Sunshine Coast University Hospital and Nambour General Hospital emergency departments, Queensland.  Andrea has 20 years’ experience in the care of older persons both in the acute, community and ED settings. She has been central to the development of the GEDI model of care using a combination of her expertise, research and collaboration in all aspects including recruitment, training, policy and model development.

She is a co-investigator for the CEDRiC research project, funded by a Department of Social Services, Aged Care Service Improvement and Healthy Ageing Grant totaling $1.15M. In addition, she is the principal investigator for a local research project to investigate the predictive validity of the interRAI ED Screener in the local population.  She is also currently working for the Clinical Excellence Division of Queensland Health to develop a toolkit to enable emergency departments in the state of Queensland to implement GEDI.  In her downtime, Andrea is a PhD candidate with a focus on Comprehensive Geriatric Assessment in the emergency department setting, a wife and mother of 3.