Geriatric Emergency Management

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The population is getting older and there are a number of barriers and challenges that frail seniors currently face, including incomplete and inaccurate assessment, re-admission to the emergency room or hospital, missed diagnoses and functional decline. Appropriate geriatric care results in better outcomes for the frail elderly, reduces their use of hospital and long-term care services and improves their quality of life.

Karen Campbell, nurse practitioner clinical nurse specialist, from specialized geriatric services, was recently seconded to the newly created position of a geriatric emergency management (GEM) nurse at LHSC, University Campus(UC). Karen received her MScN from the University of Toronto in 1980 and was a clinical nurse specialist. She then studied to be a nurse practitioner at the University of Western Ontario from 1996-1998.

Karen says, “The main purpose of the GEM role is to improve the treatment of at-risk elderly patients in hospital emergency areas and reduce recurring emergency visits and hospital admissions.”

Other goals of the program include the development and implementation of a new model of care for seniors, improved care for seniors in the emergency department and building the capacity to assess frail elderly patients within the existing system.

The role was initiated in Toronto by the Regional Geriatric Programs of Ontario (RGP)-a network of programs and services devoted to improving the health and independence of seniors in Ontario suffering from complex health problems. Eight new GEM positions have been created in Ontario: five in Toronto, one in London and one in Hamilton. The Ministry of Health and Long-Term Care approved base funding for GEM nurses to provide comprehensive geriatric assessment and co-ordination of hospital and community health-care services for at-risk elderly patients identified in the emergency department. GEM nurses develop health-care plans that address underlying health conditions, acute symptoms and home support needs.

  • Barbara Liu, Program Director of the Regional Geriatric Program of Toronto says there are many benefits to having a GEM nurse, including:
  • a team approach to complex issues;
  • the collaboration of a geriatric approach within the context of emergency department demands;
  • identification and assessment of geriatric syndromes and other missed diagnoses;
  • an enhanced linkage to community resources;
  • a trend to a reduction in return emergency department visits

Seniors are disproportionately high users of medical services. 12.3 per cent of the population is over 65 and the elderly make up 1/3 of all hospital admissions and 2/3 of all hospital stays. Their needs are different and they are more vulnerable than the rest of the population. “Elderly people often have no where else to present when they decompensate acutely,” says Dr. Michael Borrie, chair of Ontario’s five RGPs.

“A geriatric trained nurse in the emergency room can analyze the presenting geriatric syndromes, sort out the multiple issues and refer the person and their caregiver to the appropriate geriatric services. We anticipate some admissions to acute care hospital can then be avoided.”

Karen believes this role is very significant. “The population is ageing and the emergency department at St. Joseph’s Health Care is closing. There is a strong need for jobs like this as there are more health problems among seniors and they are more complex among the elderly. This role will help to keep unnecessary patients out of the emergency department and to use existing resources to reduce repeat visits and reduce the number of times people have to come in.”

The Ontario Hospital Association report on Geriatric Emergency Management (March 2003) concludes that the available research has demonstrated decreased elderly use of emergency services and increased patient and family satisfaction with the implementation of a geriatric emergency management services. The GEM nurse approach will enhance the care of seniors in the emergency department, improve communication and build capacity.

Karen has been in the GEM role since the end of March and she feels very positive about it. “The implementation of the role at LHSC UC has gone easily and that has been due to the support of the role by all levels in the hospital. Most importantly the team of nurses, social workers and physicians in the emergency department see the value and the impact on patient care,” she says.