PROJECT SUMMARY Geriatric patients (age 65 and older) use the emergency department (ED) more often than any other age group. Despite high intensity care in the ED, many geriatric patients continue to have unmet needs which lead to repeat ED visits, hospitalization, nursing home admissions, or death. EDs are designed to address patients' acute medical issues. Care in the ED centers on rapid triage and diagnosis. However, accurate diagnosis and effective treatment are more difficult in older patients with multiple comorbidities and medications. Emergency physicians receive little training on geriatric syndromes and other unique characteristics of geriatric patients. Because of these factors, ED clinicians often have limited awareness of the underlying conditions that contribute to patients' health problems. In light of these limitations geriatric emergency departments have been implemented nationwide, and geriatric ED guidelines have been agreed upon by multiple stakeholder groups. The guidelines include recommendations for enhanced expertise, educational and quality improvement expectations, equipment, policies, and protocols. The Geriatric Nurse Liaison Program (GNLP) at Northwestern Memorial Hospital is a unique model of geriatric ED care which centers on validated assessments, appropriate referral, and care coordination performed in the ED by a geriatric nurse liaison (GNL). The goal of the GNLP is to improve health care, improve health, and reduce costs for older adults by identifying and addressing the health-related needs that are not typically met in the ED. Preliminary data indicates that this program has successfully decreased inpatient admissions, however the patient and clinical factors which identify ideal candidates are unclear, and the longer term effects of the GNL model on patients' health services use and health-related quality of life (HRRQoL) are unknown. The objectives of this study are to identify patient and clinical factors which might better target the intervention, and to understand the longer term effects of the GNLP on health services use and HRQoL. We will accomplish this by 1) identifying and describing patient and clinical factors associated with discharge without GNL evaluation, and admission despite GNL evaluation, 2) describing the actions taken by GNLs after positive screening, the relationship between positive screens on GNL assessments and health-related quality of life (HRQoL), and 3) evaluating the longitudinal effects of the GEDI WISE GNL program on health services use and HRQoL for 8 weeks. Better understanding of the relative importance of each component of the GNLP, and evaluation of longer term effects on patient-centered outcomes is necessary for further dissemination of programs like the GNLP.

Project Narrative The Geriatric Nurse Liaison Program (GNLP) at Northwestern Memorial Hospital is a unique model of geriatric emergency department care which centers on validated assessments, appropriate referral, and care coordination performed in the emergency department by a geriatric nurse liaison (GNL). The objectives of this study are to identify patients most likely to benefit from the GNLP and to understand the longer term effects of the GNLP on health services use and health related quality of life.