Implementation of a geriatric emergency department program using a novel workforce

Huded, Jill M.; Lee, Albert; McQuown, Colleen M; Song, Sunah; Ascha, Mustafa; Kresevic, Denise; Maloney, Gerald E.; Smith, Todd I.

doi:10.1016/j.ajem.2020.10.039

Cited by 8 publications

(21 citation statements)

References 11 publications

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“…One unique aspect of GERI‐VET was its use of former military medics and corpsmen, ICTs, to perform geriatric screens and care coordination 13,30 . Despite no prior geriatrics experience initially, they brought strengths to the program such as Veteran to Veteran rapport and prior integration into the ED setting making them ideal transitional care liaisons.…”

Section: Discussionmentioning

confidence: 99%

“…GERI‐VET was designed to identify at‐risk older Veterans in the ED, screen for geriatric syndromes, facilitate referrals to aging‐friendly resources within and beyond the ED, and assist in care transitions. ED staff performing GERI‐VET assessments received education and training as part of the program, equipping them to provide aging‐centric care 13 …”

Section: Methodsmentioning

confidence: 99%

“…Consults were completed by ED staff labeled as GERI‐VET liaisons. GERI‐VET liaisons were Intermediate Care Technicians (ICTs; former military medics and corpsmen) 15 who received training in geriatric care through the program 13 . ICTs, who possess both nursing and provider skills through their military training, have been incorporated into clinical care in numerous VA settings including the ED.…”

Section: Methodsmentioning

confidence: 99%

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Association of a geriatric emergency department program with healthcare outcomes among veterans

Huded

Lee

Song

et al. 2021

J American Geriatrics Society

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Background We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI‐VET), the first comprehensive Veterans Affairs Geriatric ED program. Methods In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI‐VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI‐VET eligible Veterans who did not receive GERI‐VET care. Propensity score matching was used to compare outcomes in the GERI‐VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30‐day admission. Results In the ED, the GERI‐VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p < 0.001) and social work (399 [55.0%] vs. 132 [18.2%], p < 0.001). The GERI‐VET group had higher referral rates to Geriatrics (64 [17.7%] vs. 18 [5.8%], p < 0.001) and Home Based Primary Care (110 [30.4%] vs. 24 [7.8%], p < 0.001). Key outcome measures included lower rates of ED admission (363 [50.1%] vs. 417 [n = 57.5%], p = 0.003) and 30‐day hospital admission (412 [56.8%] vs. 464 [64.0%], p = 0.004) without increasing ED length of stay (5.4 ± 2.2 vs. 5.4 ± 2.6 h, p = 0.85) or 72‐h ED revisits (23 [3.2%] vs. 16 [2.2%], p = 0.25) in the GERI‐VET group. Conclusions A program designed to screen for geriatric syndromes and coordinate care among at‐risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30‐day admissions without increasing ED length of stay or re‐visitation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Association of a geriatric emergency department program with healthcare outcomes among veterans

Huded

Lee

Song

et al. 2021

J American Geriatrics Society

Self Cite

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“…The highest level must have case management and all 4 of those disciplines. 23 , 25 Geriatric assessments in accredited geriatric EDs may be performed by specially trained emergency nurses 26 , 27 , 28 , 29 , 30 or former military medics and corpsmen, 31 , 32 or in a geriatric consultation model with geriatric advanced care practitioners (APPs) 33 , 34 or physicians. 35 , 36 Studies evaluating the impact of these programs typically focused on health care use and have demonstrated that geriatric care models may decrease hospital admissions at the index ED visit, 29 , 31 , 34 , 37 hospital length of stay, 30‐day hospital readmissions 28 and overall Medicare costs at 30 and 60 days after the ED visit.…”

Section: Introductionmentioning

confidence: 99%

Developing a novel integrated geriatric palliative care consultation program for the emergency department

et al. 2022

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With the aging of our population, older adults are living longer with multiple chronic conditions, frailty, and life‐limiting illnesses, which creates specific challenges for emergency departments (EDs). Older adults and those with serious illnesses have high rates of ED use and hospitalization, and the emergency care they receive may be discordant with their goals and values. In response, new models of care delivery have begun to emerge to address both geriatric and palliative care needs in the ED. However, these programs are typically siloed from one another despite significant overlap. To develop a new combined model, we assembled stakeholders and thought leaders at the intersection of emergency medicine, palliative care, and geriatrics and used a consensus process to define elements of an ideal model of a combined palliative care and geriatric intervention in the ED. This article provides a brief history of geriatric and palliative care integration in EDs and presents the integrated geriatric and palliative care model developed.

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“…What is known on this topic 1 Within VA EDs, adults 65 years and older account for 45% of all ED visits, compared to 18% in community hospitals. 1,2 In general, compared to younger patients, older adults experience longer ED visits, higher admission rates, and more frequent ED revisits. [3][4][5][6] Older adult ED visits are often driven by unmet needs or unrecognized geriatric syndromes.…”

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confidence: 99%

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

McQuown

Snell

Abbate

et al. 2022

Health Services Research

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Objective To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age‐Friendly Health Systems via the emergency department (ED) follow‐up home visits supported by telehealth. Data Sources and Study Setting Data sources were a pre‐implementation site survey and pilot phase individual‐level patient data from six US Department of Veterans Affairs (VA) EDs. Study Design A pre‐implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high‐risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow‐up telephone, or home visits. During the follow‐up visit, ICTs identified “what matters,” performed geriatric screens aligned with Age‐Friendly Health Systems, observed home safety risks, assisted with video telehealth check‐ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. Data Collection/Extraction Methods Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May–October 2021. Principle Findings Site surveys showed none of the EDs had a formalized way of identifying the 4 M “what matters.” During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow‐up. Conclusions A post‐ED follow‐up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

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Implementation of a geriatric emergency department program using a novel workforce

Cited by 8 publications

References 11 publications

Association of a geriatric emergency department program with healthcare outcomes among veterans

Association of a geriatric emergency department program with healthcare outcomes among veterans

Developing a novel integrated geriatric palliative care consultation program for the emergency department

Telehealth for geriatric post‐emergency department visits to promote age‐friendly care

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