Background Older patients are at increased risk of longer length of stay and hospital acquired harm when they are admitted to hospital. Early access to Geriatrician review can help mitigate these risks, as well as providing care that is more in line with what matters most to patients. At our hospital access to geriatric assessment has traditionally been through inpatient acute/subacute admissions or through outpatient assessment in our public geriatric medicine clinic which has an average wait time of 2 months.
Practice change Between March and September 2024, we implemented a Geriatrician in ED initiative (GEDI) service. The principles of the GEDI pilot were to provide patients with access to timely senior decision making, provide patient-centred care which aligned with patient’s values and “what matters” to them, and coordinate care and actively facilitate dispositions from ED without causing unnecessary delay.
Results/learnings Over 70 sessions, one Geriatrician reviewed 83 patients. Involvement of GEDI significantly increased the number of patients admitted to home-based subacute teams (GEM@Home), reducing the burden on the hospital system, while aligning delivery of care where patients want to receive their care.
Conclusions Until this pilot, the perception of Geriatricians has been as specialists who work in subacute disciplines and do not fit into the culture of busy Emergency Departments. Introduction to GEDI at our hospital has put a face to the name of Geriatrics. Further change initiatives are being undertaken to embed Acute Geriatric Consults to increase access to Geriatrician reviews and earlier decision making in our hospital.