Aim: Older adults presenting to Emergency Departments (EDs) frequently experience multimorbidity, frailty, cognitive impairment, and functional decline that are not optimally addressed within traditional acute care models. The Geriatricians for Older Adults in the Emergency Department (GOLD-ED) model was implemented at Fiona Stanley Hospital to embed early comprehensive geriatric assessment (CGA) within the ED and support frailty-informed clinical decision-making. This study aimed to evaluate the clinical impact and staff experience of the GOLD referral system six months post-implementation.
Methods: A mixed-methods evaluation was undertaken. Quantitative data were collected through retrospective review of 480 consecutive GOLD referrals (March–June 2025), examining referral indications and patient disposition outcomes. Qualitative data were obtained via a multidisciplinary ED staff survey exploring awareness, perceived clinical value, barriers, and improvement strategies. Quantitative data were analysed descriptively; qualitative responses underwent thematic analysis.
Results: Falls were the leading referral indication (39.5%), reflecting frailty-related presentations. Following CGA, 55.4% of patients were admitted to an acute geriatrics ward directly, while 21.0% were discharged home or to residential care with specialist geriatric input, facilitating more appropriate and individualised care pathways. Staff reported earlier specialist involvement, improved holistic assessment, enhanced discharge planning, and reduced duplication of care. Barriers included unclear referral criteria and limited nursing awareness.
Conclusions: Integrating geriatric expertise within the ED enabled early CGA, strengthened frailty-informed care, and supported more appropriate disposition decisions. This model demonstrates the value of embedded geriatric services in acute care and provides a scalable framework for improving outcomes for older adults presenting to EDs.