EDWhat is your chief diagnosis here
today ?
Is it life-threatening ?
How efficiently, quickly can we move you through the ED, and on out to wherever you are going ?
Geriatrics
What is your current level of functioning, and how can we maintain it, prevent your losing function ?
What are all your co-morbidities ?
How do your various treatments
interact ?
Who/what are your support systems ?
What else do you require for support?
GEM
12 Toronto hospitals Hamilton, Ottawa, Kingston RGP British Columbia, Quebec Cleveland, Ohio
etc., etc.
GEM in GTA
SunnybrookScarborough Grace, GeneralNorth York GeneralToronto East GeneralSt. Joseph’s Health CentreUHN [TWH and TGH]York Central, Markham StouffvilleSt. Michael’sHRRH [Church St.]
Diverse GEM service models
Resource RNAdvanced Practice NurseNurse-ClinicianCNSScreening toolsCross-appointed staff
Sunnybrook pioneered GEM
Hospital committed to LTC [veterans] busy ED - 14,500 > 65 yrs
Pilot project, 6 months 1995-6 185 referred [vs. 13 / previous one year] GEM permanent, 5 days/week June 1996 7 days/week since 2002
GEM nurses funded by RGP and Sunnybrook
Reasons for referral
History of fallsCognitive changesPossible abuse / neglectSubstance abuseCaregiver stressCaregiver hospitalized … /2
Reasons for referral (2)
Functional declineAnxietyAcute / Chronic PainRepeated ED visits /
hospitalizationsPlacement
Referral Sources
Emergency MDs, RNs VolunteersCasefinding [computer EDIS]CommunityConsultantsAfter-Hours Referral BoxVoicemail
Geriatric Nurse- Clinician Role
AssessmentsHelp decide to admit or notCo-ordinate followupGeriatric ResearchEducation
GEM stats
Patients seen, 2002 682
Average per month 56.8 [Range 48 – 73]
Facilitated Discharges 70 %
GEM Bedside Assessment
Observation Cognitive AssessmentChart ReviewTelephone Inquiries, Professional FollowupHome Support
GEM Assessment Tools
Folstein Mini-Mental StateGeriatric Depression Scale [short form]Confusion Assessment MethodRGP Assessment Form [same
for day hospital, clinic, consult team]
Social Work screening tool
GEM Links to Community Resources
CCACsGPs, ConsultantsSGS servicesDay CareLifelineVolunteer DriversPlacement
GEM Education
Staff Inservices Orientation of new staff
Informal Education [for staff, caregivers,
patients]
Marketing of services, media
GEM on Hospital Committees
‘Crisis Visits to the ED’ group Community PartnershipGeneral Medicine Pain Collaborative ProjectQuarterly Meeting: all GEM nurse-
clinicians and all ED social workersAccreditation, Quality ImprovementED Renovation
Challenges: Clinical
Pain ManagementIsolated Seniors / Limited
FinancesCrisis PlacementAbsence of Convalescent Care
Keys to Success
Visibility Office LocationPrevious Clinical ExperienceHands-On CareTimely Followup“Practical Tips for Seniors Visiting ED” … /2
Keys to Success (2)
FlexibilityMarketing / OrientationCollaboration with Key PlayersLinking to Community ResourcesPartnershipsFeedback / ED Evaluation Forms … /3
Toronto RGP - Core Services provided by members
Outreach teamsAmbulatory care clinicsInternal consultation teamsGeriatric Rehabilitation UnitsAcute Geriatric UnitsDay HospitalsGeriatric Emergency
Management
RGP GEM Task Force
To spread the word, share knowledgeProject Manager hired February, 2002
Members: 12 hospitals, ED & Geriatrics Quarterly meetingsSubcommittees ad hoc re screening
tools, elder-friendly environment, etc.
GEM Task Force Five Initial Priorities
High risk screening toolNeeds AssessmentGeriatrics Education for
Professionals
Elder-friendly EDPolicy Paper
Consultations to Hospitals
For hospitals seeking to improve geriatric emergency management
What is possible even if you cannot hire a specialized geriatric nurse for the ED
“Toolkit”
Workshop outline
Observation Guide, for elder-friendly ED
High-risk screening tool
Needs assessment, data analysis support
Electronic listserves
Ideas for Future GEM
‘geri area’ in ED
Strategic partnerships between LTC, acute care hospitals [examples]
Research : EMS workers gather information
Contact
Lisa Newman, MSW MHScProject ManagerRGP GEM Task Force
(416) 480-6100 #7334