A Randomized Controlled Trial of Geriatric Emergency Department Innovations - Project Summary
Geriatric patients use the emergency department (ED) more than any other age group. Once in the ED,
geriatric patients have longer stays, receive a greater number of diagnostic tests, and are more likely to be
hospitalized than younger adults. ED visits for geriatric patients are sentinel health events. If geriatric patients
are discharged, they often return to the ED or are hospitalized and experience declines in health-related quality
of life (HRQoL) and disability. If they are hospitalized, they incur increased costs and greater risk for poor
outcomes including infections, delirium, and falls. Suboptimal acute care for geriatric patients is a problem
nationally, resulting in development of national geriatric emergency department guidelines and endorsement by
prominent stakeholder groups. To improve acute care for geriatric patients, Northwestern Memorial Hospital
implemented the Geriatric Emergency Department Innovations (GEDI) program. GEDI is an integrated,
interdisciplinary approach to ED care for geriatric patients; it applies evidence-based protocols to improve ED
care and improve transitions from the ED to the community. The program centers on geriatric nurse liaisons
(GNLs) who are ED nurses with additional training in geriatrics and whose time is dedicated to GEDI rather
than traditional bedside nursing. When consulted by the ED team, GNLs perform validated assessments and
coordinate patient care in the ED, hospital, or outpatient setting. Through this assessment and coordination
model, GEDI provides patient-centered care and aims to prevent unnecessary hospitalizations. Though GEDI
was built on the best available evidence, and reflects the Geriatric Emergency Department guidelines
supported by multiple national stakeholder groups, there are no prospective efficacy studies in the U.S. of ED-
based programs for geriatric patients like GEDI. Therefore, GEDI's efficacy has not been tested
prospectively. We propose a randomized controlled trial (RCT) to determine the efficacy of GEDI at a high-
volume, urban hospital. Additionally, identifying patients most likely to benefit from GEDI is difficult. Available
instruments have poor predictive validity for hospitalization, return to the ED, and functional decline. However,
the “Emergency Geriatric Review and Evaluation Tool” (EGRET), which was developed with AHRQ funding, is
a promising screener to identify older adults who may benefit from GEDI. A RCT of GEDI will be strengthened
by using EGRET to screen geriatric patients at risk of poor outcomes. This study addresses several AHRQ
priority populations: women, minorities, inner-city, End-of-Life, low income and the elderly.
