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Geriatric Emergency Department Intervention (GEDI) Toolkit
Report   Open access

Geriatric Emergency Department Intervention (GEDI) Toolkit

Elizabeth J Marsden, Andrea Taylor, Marianne Wallis, Alison Craswell, Nicolette Bannink, Marc Broadbent and Colleen Johnston
pp.1-86
Queensland Health, Health Improvement Unit
2017
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Geriatric Emergency Department Intervention (GEDI) Toolkit3.43 MBDownloadView
Published VersionCC BY-NC-ND V3.0,  Open Access
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http://cedric.org.au/gedi-toolkit-2/View
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Abstract

Worldwide, ageing populations are placing increasing pressure on health services for the management of acute illness and exacerbation of chronic conditions in older persons. In 2015, over 20% of Sunshine Coast residents were aged 65 years and over compared to 15% in Australia (ABS, 2017). Emergency department (ED) presentations and hospital admissions for older persons is associated with an increased risk of complications compared to younger cohorts (Ackroyd-Stolarz, Read Guernsey, Mackinnon, & Kovacs, 2011; Briggs, Coughlan, Collins, O’Neill, & Kennelly, 2013; Dwyer, Gabbe, Stoelwinder, & Lowthian, 2014; Mudge, Denaro, & O'Rourke, 2012; L. Schnitker, Martin-Khan, Beattie, & Gray, 2011; Schnitker, Beattie, Martin-Khan, Burkett, & Gray, 2016). Appropriate care of this vulnerable cohort is critical to improving care for the older person and managing shrinking health dollars. The Geriatric Emergency Department Intervention (GEDI), operating in the ED of Nambour General Hospital, Sunshine Coast Hospital and Health Service (SCHHS), is a service providing specialist and targeted care for persons aged 70 years and over who present to the ED. The GEDI team comprises of a Clinical Nurse Consultant, ED physician and Clinical Nurses providing ‘front load’ assessment within the ED to prioritise assessment and management of frail older persons. GEDI nurses aim to avoid inappropriate hospital admissions of older persons whilst streamlining their care to the right place, right person at the right time. This aligns with the Australian Charter of Healthcare Rights (Australian Commission on Safety and Quality in Healthcare, 2008) and SCHHS (2014) purpose “To deliver the highest standards of safe, accessible, sustainable, evidence-based health care with a highly skilled and valued workforce that optimises the wellbeing of our community”. The GEDI model builds upon successful interventions, such as comprehensive geriatric assessment (Ellis, Marshall, & Ritchie, 2014), by tailoring interventions to the ED environment. The GEDI service was evaluated utilising the Donabedian (2003) Structure, Process and Outcome framework. Data on the GEDI model were collected over a 12-month period from September 2015 to August 2016. This data was compared with historical outcome data from the pre-GEDI period January until December 2012 and the interim GEDI period, January 2013 through until August 2015. Outcome measures included disposition, ED length of stay, hospital length of stay and re-presentation to 28 days. Qualitative data to understand structure and processes of the GEDI service were collected from interviews with GEDI patients, families or carers and ED staff. The older person cohort in this evaluative research study were on average 81 years of age, 50-52% being female across all three data collection periods. The results of the data analysis indicated that older persons who presented to the ED during the full GEDI intervention period benefited with statistically significant reduction in ED length of stay and increased likelihood of discharge compared to pre-GEDI. No significant difference in risk of mortality or risk of same cause representation to 28 days was found. Reductions in length of stay and increased rate of discharge resulted in average cost savings per ED presentation of $35 [95% CI: $21, $49] and savings of $1,469 [95% CI: $1,105, $1,834] per hospital admission. Aggregated data from interviews with seven GEDI patients, families and carers and 23 staff determined that the service has become an integral part of ED patient care, it facilitates efficient time management with better patient and staff satisfaction. The Geriatric Emergency Department Intervention is highly successful in improving the care of older persons in the ED.

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