ED zWhat is your chief diagnosis here today ? z Is it life-threatening ? z How efficiently, quickly can we move you through the ED, and on out to wherever you are going ?
Geriatrics zWhat is your current level of functioning, and how can we maintain it, prevent your losing function ? zWhat are all your co-morbidities ? zHow do your various treatments interact ? zWho/what are your support systems ? zWhat else do you require for support?
12 Toronto hospitals z Hamilton, Ottawa, Kingston RGP z British Columbia, Quebec z Cleveland, Ohio z etc., etc.
GEM in GTA zSunnybrook zScarborough Grace, General zNorth York General zToronto East General zSt. Joseph’s Health Centre zUHN [TWH and TGH] zYork Central, Markham Stouffville zSt. Michael’s zHRRH [Church St.]
GEM Service Models Diverse models Particular to each hospital’s needs, resources
Diverse GEM service models zResource RN zAdvanced Practice Nurse zNurse-Clinician zCNS zScreening tools zCross-appointed staff
Sunnybrook pioneered GEM zHospital committed to LTC [veterans] busy ED - 14,500 > 65 yrs zPilot project, 6 months 1995-6 185 referred [vs. 13 / previous one year] zGEM permanent, 5 days/week June 1996 7 days/week since 2002 zGEM nurses funded by RGP and Sunnybrook
Role Models Montreal site visits zJewish General zRoyal Victoria zMontreal General
Fear Sunnybrook ED biggest fear, introducing GEM: zIncreased LOS in ED
GEM Assessment Tools zFolstein Mini-Mental State zGeriatric Depression Scale [short form] zConfusion Assessment Method zRGP Assessment Form [same for day hospital, clinic, consult team] zSocial Work screening tool
GEM Links to Community Resources zCCACs zGPs, Consultants zSGS services zDay Care zLifeline zVolunteer Drivers zPlacement
GEM Education zStaff Inservices zOrientation of new staff zInformal Education [for staff, caregivers, patients] zMarketing of services, media
GEM on Hospital Committees z‘Crisis Visits to the ED’ group zCommunity Partnership zGeneral Medicine Pain Collaborative Project zQuarterly Meeting: all GEM nurse- clinicians and all ED social workers zAccreditation, Quality Improvement zED Renovation
Challenges: Clinical zPain Management zIsolated Seniors / Limited Finances zCrisis Placement zAbsence of Convalescent Care
Toronto RGP activities zLeadership zAdvocacy zService zEducation zResearch
Toronto RGP - Core Services provided by members zOutreach teams zAmbulatory care clinics zInternal consultation teams zGeriatric Rehabilitation Units zAcute Geriatric Units zDay Hospitals zGeriatric Emergency Management
RGP GEM Task Force zTo spread the word, share knowledge zProject Manager hired February, 2002 zMembers: 12 hospitals, ED & Geriatrics zQuarterly meetings zSubcommittees ad hoc re screening tools, elder-friendly environment, etc.
GEM Task Force Five Initial Priorities zHigh risk screening tool zNeeds Assessment zGeriatrics Education for Professionals zElder-friendly ED zPolicy Paper
Consultations to Hospitals zFor hospitals seeking to improve geriatric emergency management zWhat is possible even if you cannot hire a specialized geriatric nurse for the ED
“Toolkit” zWorkshop outline zObservation Guide, for elder-friendly ED zHigh-risk screening tool zNeeds assessment, data analysis support zElectronic listserves
Ideas for Future GEM z‘geri area’ in ED zStrategic partnerships between LTC, acute care hospitals [examples] zResearch : EMS workers gather information