Introduction of Geriatric Medicine Multidisciplinary Service to Emergency Department

Abstract

Abstract Background Ireland has an ageing demographic with a significant community dwelling population living with frailty. Identification of frailty at the hospital front door via a Geriatric Emergency Multidisciplinary Service (GEMS) was expanded in October 2023 with the aim to trigger early comprehensive geriatric assessment (CGA) in the Emergency Department (ED)and to ensure that older people with frailty are diverted to the most appropriate services as quickly as possible and, where appropriate, discharged home on the same day. Methods Using Plan Do Study Act (PDSA) cycle framework a screening pathway for all over 75-year-olds who present to ED was established. The service provides screening for frailty and delirium (using 4AT) in the ED with high clinical frailty scores (CFS) or requiring specialist input were selected for CGA. Information was collected on all patients on admission and data was also collected on discharge destination and readmission rates. Results 1308 patients were reviewed since introduction with average age 82.3 years (68-101). 63.6% (832) patients had CGA and 36.4% (476) were screened. Of those who did not have a CGA, 46.1% (185) were not frail with CFS 3 or less. Average CFS was 4.84 and average 4AT score was 2. 46.7% (611) of patients reviewed were discharged from ED with discharge rates increasing from 40.9% (93) in November 2023 to 49.5% (104) in April 2024 and 28-day readmission rates decreasing from 6.87% in April 2023 to 5.98% in March 2024. Conclusion This quality improvement project highlights the impact of GEMS in the ED in reducing admission rates and readmissions. Ongoing areas for improvement include expanding the service to review all patients identified with frailty where possible, and in the future establishing pathways for improved access to community services/supports to further reduce readmission rates and to capture the impact on length of stay.