Aim
Models of care for older adults who present to Emergency Departments (EDs) are evolving; one such model is a geriatrician embedded in ED. We performed a quantitative and qualitative evaluation of the Geriatric Emergency Department Initiative (GEDI) at Austin Health, to understand the efficacy, implementation factors and mechanisms of this model.
Methods
Quantitative evaluation of GEDI entailed an interrupted time series analysis of ED presentations of people aged over 75. Multidisciplinary ED staff were interviewed for qualitative evaluation. Interviews were analysed, guided by the consolidated framework for implementation research (CFIR) and also using realist methodology.
Results
Interrupted time series analysis revealed that admission rates of older adults were decreasing by 0.1% / month prior to GEDI introduction. After GEDI implementation, admission rates decreased by 1.2% / month. ED length of stay (EDLOS) was increasing by 0.08 hours /month prior to GEDI but decreased by 0.207 hours / month after. Re-presentation rates were not affected.
Interview analysis using CFIR revealed that factors enabling integration of GEDI were timely access to geriatric expertise and collaborative environments. Challenges included standardisation of referral pathways, fluctuating staff awareness, and limited service capacity.
Evaluation using realist methodology revealed that GEDI triggered timely discharge planning, improved care transitions and fostered capability building by and boundary spanning and engendering trust.
Conclusions
In a large teaching hospital, GEDI decreases admission rates and EDLOS without adversely affecting representation rates, consistent with meta-analyses. Understanding mechanisms and implementation factors will assist with the scale and spread of similar models elsewhere.