Top 10 articles on the Geriatric Emergency Department

In Emergency Departments, we tend to follow the evidence to make practice change. However when creating a geriatric ED, the evidence sometimes is lacking:  adopting or adapting “best practices” may be more appropriate. Here are some key articles that you may find valuable in your search for evidence AND best practice.  Click on the title to access a pdf of the article.

Please add your own preferred articles in the comments section.

1. The Geriatric Emergency Department

Ula Hwang and Sean Morrison from New York City in 2007 wrote a paper about how an Emergency Department can modify its model of care for the older adult population. They refer to the GEDI (Geriatric Emergency Department Intervention) that they have implemented in their ED. Does it work? They don’t say, it is mostly descriptive but the guidelines found an inspiration there.

2. A Systematic Review and Qualitative Analysis to Inform the Development of a New Emergency Department-Based Geriatric Case Management Model

Samir Sinha et al. in 2011 published a systematic review about models of care in the emergency department. Of the 352 articles they reviewed, the successful EDs shared mainly eight characteristics: based on evidence; involved nursing leadership; included high risk screening; focussed geriatric assessment;  disposition planning early in the ED visit; interdisciplinary team; post-discharge follow-up; and monitoring of processes.

3. Rapid Two-stage Emergency Department Intervention for Seniors: Impact on Continuity of Care

Jane McCusker et al. in Montreal in 2003 did a randomized controlled study on high risk older adults. The intervention was to have a focussed geriatric assessment by a specialized nurse who could refer the patient to community services, hospital outpatient clinics or to their primary care physicians. This is a rare randomized controlled trial about geriatric emergency care.

4. The Elder-Friendly Emergency Department Assessment Tool: Development of a Quality Assessment Tool for Emergency Department–Based Geriatric Care

This article follows the work of the previous study (number 3) by the same research group from Montreal. And provides a practical brief check-list of the essential features of an elder-friendly ED.

5. A New Model for Emergency Care of Geriatric Patients

Adams and Gerson in 2003 wrote a brilliant commentary about the new model for emergency care in geriatric patients.

6. Care coordination in the Emergency Department: improving outcomes for older patients

Corbett et al. in 2005 in Australia published a quality improvement (QI) research about a care intervention for older adults and its effect on admission and revisit. This is a good example of a well reported QI project.

7. Geriatric Emergency Department Innovations: Preliminary Data for the Geriatric Nurse Liaison Model

Aldeen et al. developed in 2013 in Chicago a brief training for geriatric specialized nurses and studies the impact of their work compared to usual care. They found a significative admission reduction.

8. Quality care for older people with urgent and emergency care needs in UK emergency departments

Matthew Cooke, Jay Banerjee et al.  in England wrote the Silver Book, which sets quality standards for the emergent and urgent care of older people who are ill or injured.   It is a rich and comprehensive resource that brought together practitioners from 14 different disciplines.

9. Four Sensitive Screening Tools to Detect Cognitive Dysfunction in Geriatric Emergency Department Patients: Brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the Caregiver- completed AD8

This is a great review of cognitive impairment screening tools for the Emergency Department published by Carpenter et al. in 2011.

10. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

And finally, if you are interested in research, Carpenter et al. in 2011 identified several high yield research questions in geriatric emergency medicine.