UC Irvine

Despite the geriatric patient’s high utilization of the Emergency Department (ED), the care delivery models guiding traditional emergency care fail to address the complexity of the older adult, thus resulting in poor patient outcomes. In response, geriatric emergency experts have developed the Geriatric ED Accreditation and the 2014 consensus guideline to standardize best practice; despite these efforts, geriatric emergency care remains heterogenous as most EDs struggle to implement the guideline. An analysis of innovations to establish Geriatric EDs across a large, academic medical healthcare system will highlight the barriers to implementation of the 2014 guidelines and identify paths to advance geriatric care. This qualitative study aimed to characterize and evaluate team member composition (Geriatric Emergency Nurse Initiative Expert to Geriatric Expert Practitioner), as well as the structures and processes in Geriatric EDs across the healthcare system. Data from open-ended, semi-structured interviews with geriatric emergency leaders and observations in two leading Geriatric ED of academic healthcare system, were analyzed for content and themes. Geriatric emergency leaders reported widespread recognition that geriatric expertise, as currently implemented across the healthcare system, lacks a foundational care delivery model for implementation. Specifically, this analysis generated the following recommendations: advanced practice nursing to guide capacity development; a foundational care delivery model for patient assessment and care coordination; and a multidisciplinary team-based approach to care delivery. Importantly, institutional leaders also reported a high level of organizational readiness for change. The slow development of geriatric expertise in the ED stems from the absence of well-evidenced, model-based care delivery and assessment. Implementation of geriatric assessment grounded in the Comprehensive Geriatric Assessment Model, and geriatric emergency care delivery founded upon the Geriatric Practitioner Model, will serve to inform role development, develop successful care processes, and improve team coordination. Adoption of a model-based approach to geriatric expertise in the ED may become the pathway toward increasing the current number of accredited Geriatric EDs (4%), and toward improving the delivery of competent and compassionate geriatric emergency care.