Profile of a geriatric emergency department (ED) model for older adults with complex needs includes sample policies and workflows as well as recommendations to support effective implementation.
Older adults often present to the ED with multiple and interrelated issues such as polypharmacy, multiple chronic conditions, atypical signs of disease, geriatric syndromes such as cognitive and functional impairments, and social needs such as a lack of social support. Geriatric EDs (GEDs) can help better address these complex care needs. The GED model of care leads to improved health outcomes and reduced lengths of stay and rates of hospital admission. This clinical review highlights the policies and workflows of GEDs at University of California, San Diego Health.
The profiled GED model of care includes an interdisciplinary team, implementation of evidence-based protocols for geriatric care, physical modifications to accommodate older adults’ functional impairments, and care coordination to support care transitions. The GED administers validated assessments that screen for geriatric syndromes and social needs such as malnutrition and elder abuse. This resource outlines the roles of core GED clinical and interdisciplinary team members and describes GED workflow and physical modifications in the ED environment. The authors note two key challenges in GED implementation: building the informatics infrastructure and ensuring that all staff are adequately trained in geriatric care.
Health system administrators interested in implementing a GED can apply the information in this clinical review to address the complex health needs of older adults presenting to the ED setting. Key recommendations include developing a care planning team, conducting an institutional needs assessment, and using the 4Ms guide for age-friendly health systems to support the successful implementation of this model.