Background: Delivering individualised chronic and complex care for older persons is an increasing challenge faced by hospitals. Presentations to Emergency Departments and fragmented inpatient journeys all too often result in unnecessary distress. This is particularly apparent with low value hospitalisations and when exposure to iatrogenic harm. A limited number of Australian health services have shown success with earlier access to geriatricians leading to reduced hospital LOS and representation . Queensland Health has demonstrated successful implementation with Geriatric Emergency Department Intervention as a nurse-led approach.
Change: GEDI at Austin Health stands for Geriatric Emergency Department Innovation affectionately known as Jedi. We implemented GEDI as a seven day a week service with geriatrician embedded in the ED providing proactive and time-sensitive senior decision making directing disposition of vulnerable patients, generally over the age of 65 years. This includes direct access to acute geriatric medicine beds, rehabilitation beds, community programs including residential-in-reach and bed substitution models such as Better@Home. GEDI geriatricians also identify admitted patients on the Emergency Department floor that would benefit from early geriatric medicine consultation (within 24-48 hours of inpatient stay). This integration in ED allows us to support earlier multidisciplinary trauma, general medicine and surgical care of the older person subsequently admitted. Our early trends see GEDI geriatricians discharging 47% of patients with uncertain disposition referred for advice by the ED and a 48-hour representation rate of 2% (below pilot study rate of 7%).
Learnings:
Geriatricians are well placed as dynamic complex care practitioners to value-add outside of traditional wards and community roles supporting dignified and effective care of the older person.
Patient flow and access difficulties can be disrespectful to patients who inadvertently feel less than entitled accessing acute public health which can be contributed to, by collective decisions made at points of care, limited staff and resource availability. Contributing to timely solutions post coronavirus pandemic era, can sometimes mean flying the starship while building it however we are heartened by other Victorian metropolitan hospitals anecdotally also reporting some success. Establishing a GEDI Interest Group is the beginnings of focusing a community of geriatricians, improve quality of care delivered and the level of engagement, ensuring we are charged with delivering the right care in the right place at the right time from the point of first contact . This has far reaching implications for virtual ED roles, education of medical staff, minimising restrictive practice and non-beneficial interventions.