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.

Project Narrative The Geriatric Emergency Department Innovations (GEDI) program 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 evaluate the efficacy of GEDI by performing a randomized controlled trial, and to evaluate the Emergency Geriatric Review and Evaluation Tool” (EGRET) to identify patients most likely to benefit from GEDI.