Evaluation of the Geriatric Emergency Department Intervention (GEDI) implementation

Grant ID: EMPJ-381R27-2017

Project Summary

Advances in health have led to populations living longer with more chronic disease and frailty. Frail older people presenting to emergency departments (EDs) have special needs that are often overlooked. In response, the innovative Geriatric Emergency Department Intervention (GEDI) was developed by clinicians at Nambour Hospital, Queensland.

GEDI is a unique nurse-led, physician-championed model of service delivery which facilitates advanced assessment tailored to the individual, nurse-initiated specialist referral, fast-tracking of care through the ED and appropriate safe discharge planning for persons aged 70 and over, including those from residential aged care facilities. A successful trial in one ED was awarded the 2016 Queensland Premier’s Award for Excellence. The evaluative research we conducted found that when older adults presented to ED during the times the GEDI team was working they were more likely to be discharged, if admitted they spent, on average, 24 hours less in hospital and the costs of their care were reduced by up to 30%.

The staffing for a trial of GEDI in two further Queensland EDs will be funded by the Queensland Health Improvement Unit. This EMF-funded evaluation project employs the principles of implementation science to evaluate the introduction of GEDI into these EDs to determine whether the knowledge learned from the trial can be translated to other sites and to determine the best strategies for future implementations of GEDI across Queensland and interstate. If implementation is found to be successful future roll out of GEDI will improve patient outcomes and reduce costs in Queensland and across the country.

Leveraged Funds

- Queensland Health, Health Improvement Unit: $1,160,000

Dissemination

Publications:

- Wallis, M., Craswell, A., Marsden, E., Taylor, A., 2022. Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. BMC health services research, 22(1), 1-14.

- Marsden, E., Craswell, A., Taylor, A., Barnett, A., Wong, P. K., Wallis, M., 2022. Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults. BMC geriatrics, 22(1), 1-11.

- Marsden, E., Craswell, A., Taylor, A., Coates, K., Crilly, J., Broadbent, M., Glenwright, A., Johnston, C. and Wallis, M., 2018. Nurse‐led multidisciplinary initiatives to improve outcomes and reduce hospital admissions for older adults: The Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration project. Australasian journal on ageing, 37(2), pp.135-139.

- Wallis, M., Marsden, E., Taylor, A., Craswell, A., Broadbent, M., Barnett, A., Nguyen, K.H., Johnston, C., Glenwright, A. and Crilly, J., 2018. The geriatric emergency department intervention model of care: a pragmatic trial. BMC geriatrics, 18(1), pp.1-9.

- Marsden, E., Taylor, A., Wallis, M., Craswell, A., Broadbent, M., Barnett, A., Nguyen, K.H., Crilly, J., Johnston, C. and Glenwright, A., 2017. A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol. BMC geriatrics, 17(1), pp.1-8.

Presentations:

- Marsden E. (speaker), Taylor A., Craswell A., Barnett A., Wallis M. (2021) Implementation science regarding the roll out of our GEDI project statewide and the lessons we learnt. GEMSEM2021 THE SILVER TSUNAMI: Turning Trauma Challenges Into Opportunities, 6 May, Melbourne, Australia.

- Wallis M. (speaker), Craswell A., Marsden E., Taylor A., Barnett A. (2019) Translation of a health service innovation for older people: Implementation of the Geriatric Emergency Department Intervention into a new emergency department. 11th Health Services and Policy Research Conference (HSRAANZ), 4-6 Dec. Auckland, New Zealand.

- Craswell, A., Marsden, E., Taylor, A., Barnett, A., Wallis, M., (2019) Improving emergency care for aged care for aged care residents: the Geriatric Emergency Department Intervention. Sunshine Coast Hospital and Health Service (SCHHS) Research Day, 6 Nov. Birtinya, Australia.