Wednesday 1 February 2023

Austin Health has recently started a new program in its Emergency Department to support some of its most vulnerable patients. The Geriatric Emergency Department Innovation, or more affectionally known as GEDI, aims to provide specialist support to identify patients that would benefit from early geriatric review.

Geriatricians are physicians who traditionally do not go into Emergency Department but work on wards caring for older persons with complex chronic disease - delirium, dementia, complex decision making to manage competing interests with chronic disease and psychosocial needs.

Lead by clinicians and Geriatricians Dr Lannie Ho and Dr Kathryn Lee, the team is filling an unmet need among our patient cohort to ensure our community has access to the right specialists at the right time.

Initially starting as a COVID-surge pilot project, GEDI has established itself among their ED colleagues as an essential service.

Following a four-month pilot in 2021-2022, the GEDI program saw the following improvements in care of older patients in the ED:

- Early support of time-sensitive decisions for patient disposition (e.g. admission vs home) where up to 90 per cent of initially referred patients had an unknown disposition

- Forty-seven per cent of patients discharged home with earlier access to geriatrician-led care in the community, to provide additional support and prevent recurrent presentations to hospital.

- Markedly reduced re-presentation rates to ED (seven per cent 1-month representation rate) vs. benchmark literature (12-20 per cent 1-month representation rate1)

- Positive qualitative feedback from inpatient and ED medical and allied health staff regarding this collaboration

“Older persons wish to live well however our brittle healthcare system can challenge this. The pilot demonstrates that with geriatrician visibility we can make an earlier difference to our community at the front step of the hospital,” said Lannie.

Beyond connecting patients with the right specialists, having dedicated geriatricians in the Emergency Department provides several additional benefits, including an increase in appropriately supported safe discharge, reducing the length of stay in hospital, reducing morbidity, and fast-tracking patient assessment and decision-making.

“Our patients are some of the most vulnerable in the hospital, and early identification and management of complex geriatric issues is essential to providing them the highest quality of patient-centred care,” said Kathryn.

However, work doesn’t stop within the Emergency Department walls. Support and ongoing education of management of older person in ED is key to embedding this type of work into our everyday.

“Attendance at the Emergency department is often associated with great distress. The opportunity for select patients to be safely managed in their own familiar environment,

can do much to ensure effective recovery, minimise disorientation and support the desire for many older people to avoid unnecessary admission. GEDI is an important opportunity to add support to the splendid work done in ED, being part of the solution and supporting the Austin Value – Together we achieve.

GEDI is the vanguard of delivering service and support to the whole hospital at point of care, where and when needed, avoiding the cookie cutter traditional model where subacute services can be too little too late,” says A/Prof Michael Murray, Director of Geriatric Medicine at Austin Health.

 

1. Ref Braes T, Moons P, Lipkens P, Sterckx W, Sabbe M, Flamaing J, et al. Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging clinical and experimental research. 2010;22(4):345-51.