Admission to GIM, Emergency Geriatric Care, Geriatric Health, Length of Stay
Conditions
Keywords
emergency department, multidisciplinary team, early intervention, hospital-associated disability
Brief summary
The care of geriatric patients frequently involves members of the multidisciplinary care team, including both primary medical staff and allied health professionals. Often, members of the multidisciplinary care team are mobilized after geriatric patients have presented to the emergency department and have been seen by a doctor. Mobilizing these resources sequentially in inefficient and can lead to delays in geriatric patients receiving holistic care early following their presentation to the emergency department. The goal of this observational study is to assess the impact of having a geriatric-focused multidisciplinary team (Geri-MDT) dedicated to the emergency department that can be mobilized easily and in parallel at the time of presentation. The main questions we hope to answer in this study are: * Does the Geri-MDT increase care efficiency by reducing the amount of time patients spend in the ED? * Does the Geri-MDT decrease the proportion of patients that are ultimately admitted to the hospital? * When patients are admitted, does the Geri-MDT reduce the length of stay in hospital?
Detailed description
Older adults represent a growing proportion of the population and frequently present to hospitals with complex medical, cognitive, functional, and psychosocial needs that require interdisciplinary management. They are also at heightened risk of functional decline when accessing health services, with delays in care coordination contributing to unnecessary hospitalizations and hospitalization-associated disability. Improving outcomes for this population requires proactive, collaborative mobilization of multidisciplinary teams at the time of presentation, rather than reactive or fragmented responses. To address this need, we established a Geriatric Multidisciplinary Team (Geri-MDT) dedicated to the emergency department (ED). The Geri-MDT includes a geriatric nurse, physiotherapist, occupational therapist, social worker, and geriatrician, who together provide early triage and coordinated care for older adults presenting to the ED. We hypothesized that early, well-coordinated involvement of this team would reduce ED length of stay, decrease unnecessary admissions, and shorten inpatient admissions when required.
Interventions
None listed
Sponsors
St. Mary's Research Center, Canada
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
for the retrospective analysis were: 1. evaluation by at least one allied health professional, including a geriatric nurse, geriatrician, physiotherapist, occupational therapist, or social worker; 2. age 65 years or older; and 3. availability of the medical record in the hospital's electronic medical record (EMR) system.
Exclusion criteria
(1) data not available in the EMR. In the post-implementation period, patients were flagged for Geri-MDT assessment if they met any of the following criteria: 1. age over 85 years, 2. a score of ≥4 on the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7) frailty screening tool, or 3. an ED presentation related to a geriatric syndrome (e.g., fall, delirium, dementia, urinary incontinence, functional decline, or elder abuse).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Admission rate | From enrolment to the end of the study period, up to 1 year. | The proportion of geriatric patients that present to the emergency department that are admitted as inpatient to the hospital. |
| Time in emergency department | From enrolment to the end of the study period, up to 1 year. | The length of time, in hours, Geriatric patients spend in the emergency department. |
| Length of hospitalization | From enrolment to the end of the study period, up to 1 year. | The length of time, in days, that patients spend in the hospital if admitted. |
| Return to emergency department | Quantified as either representing to the emergency department within 7- or 30-days following discharge. | The rate of patients returning to the emergency department following discharge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mobilization of geriatric multidisciplinary team members | From enrolment to the end of the study period, up to 1 year. | The number and proportion of geriatric patients presenting to the emergency department who are seen by one or more members of the multidisciplinary care team. |
Countries
Canada
Outcome results
None listed