The Geriatric Emergency Department Intervention model of care: a pragmatic trial

Marianne Wallis; Elizabeth J Marsden; Andrea Taylor; Alison Craswell; Marc Broadbent; Adrian Barnett; Kim-Huong Nguyen; Colleen M Johnston; Amanda Glenwright; Julia Crilly

doi:10.1186/s12877-018-0992-z

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The Geriatric Emergency Department Intervention model of care: a pragmatic trial

Journal article

Open access

Peer reviewed

The Geriatric Emergency Department Intervention model of care: a pragmatic trial

Marianne Wallis, Elizabeth J Marsden, Andrea Taylor, Alison Craswell, Marc Broadbent, Adrian Barnett, Kim-Huong Nguyen, Colleen M Johnston, Amanda Glenwright and Julia Crilly

BMC Geriatrics, Vol.18, 297

2018

DOI: https://doi.org/10.1186/s12877-018-0992-z

Appears in UniSC Diversity and Inclusion Research Collection

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Abstract

geriatric

emergency medical services

nurses' practice patterns

hospital

homes for the aged

delivery of health care

protocol

outcomes

evaluation

pragmatic paradigm

UniSC Diversity Area - Life Stages

Background: To evaluate a Geriatric Emergency Department Intervention (GEDI) model of service delivery for adults aged 70 years and older. Methods: A pragmatic trial of the GEDI model using a pre-post design. GEDI is a nurse-led, physician-championed, Emergency Department (ED) intervention; developed to improve the care of frail older adults in the ED. The nurses had gerontology experience and education and provided targeted geriatric assessment and streamlining of care. The final format included 2.4 full time equivalent nurses working 7 days from 0700 h to 1730 h (1530 h at weekends). There were three implementations periods: pre-implementation (2012); a developmental phase from January 2013 to August 2015; and full implementation from September 2015 to August 2016. The outcomes measured were disposition (discharged home, admitted or died); ED length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to ED re-presentation up to 28 days post-discharge; in-hospital costs. The setting was a tertiary hospital ED, with 385 beds, in Queensland, Australia. Approximately 53,000 patients presented to the ED annually with 20% aged 70 years and older. All patients over the age 70 who presented to the ED between January 2012 and August 2016 (n = 44,983) were included in the trial. Results: Older persons who presented to the ED when the GEDI team were working had increased likelihoods of discharge (Hazard ratio (HR) = 1.19; 95% CI: 1.13-1.24) and reduced ED length of stay (HR = 1.42; 95% CI: 1.33-1.52) compared with those who presented when GEDI were not working. There was no increase in the risk of mortality (HR = 1.01; 95% CI = 0.23-4.43) or risk of same cause re-presentation to 28 days (HR = 1.21; 95% CI: 0.99-1.49). The GEDI service resulted in average cost savings per ED presentation of $35 [95% CI, $21, $49] and savings of $1469 [95% CI, $1105, $1834] per hospital admission. Conclusions: Implementation of a nurse-led physician-championed model of ED care, focused on frail older adults, reduced ED length of stay, hospital admission and if admitted, hospital length of stay and cost, without increasing mortality or same cause re-presentation. These increases were sustained over time and after the initial implementation team had changed roles.

Details

Title: The Geriatric Emergency Department Intervention model of care: a pragmatic trial
Authors: Marianne Wallis (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Elizabeth J Marsden (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Andrea Taylor (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Alison Craswell (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Marc Broadbent (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Adrian Barnett (Author) - Queensland University of Technology
Kim-Huong Nguyen (Author) - University of Queensland
Colleen M Johnston (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Amanda Glenwright (Author) - Sunshine Coast PHN
Julia Crilly (Author) - Griffith University
Publication details: BMC Geriatrics, Vol.18, 297; 9
Publisher: BioMed Central Ltd.
Date published: 2018
DOI: 10.1186/s12877-018-0992-z
ISSN: 1471-2318
Copyright note: Copyright © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Organisation Unit: School of Health - Nursing; University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy
Language: English
Record Identifier: 99451376302621
Output Type: Journal article

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Web Of Science research areas: Geriatrics & Gerontology; Gerontology

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