1. SUMMARY Emergency Departments (EDs) are an essential service for the care of injuries and trauma for everyone. They provide a safety net when the system of care is disrupted and services are unavailable. ED care is especially important for seniors who, while approximately 14% of the population, account for up to 21% of ED encounters. But not all seniors use EDs more than younger people. An increase in ED usage is primarily seen for seniors whose age (>75 years) places them at increased risk of the complex, bio-psycho-social and functional challenges of frailty. When frail seniors visit emergency departments they have more emergent conditions, receive more tests, have longer ED stays and are more likely to be admitted into hospital than younger patients. For frail seniors, an ED admission may be a sentinel event. Rates of hospitalization, return ED visits and death in the months following a visit are higher for frail seniors than for younger age groups A Geriatric Emergency Management Nursing Network has emerged as an evidence informed best practice to help achieve better health outcomes for frail seniors in the ED. The GEM network is comprised of 97 advanced practice nurses in 60 EDs in 13 Local Health Integration Networks (LHINs) across the province. At its recent 9 th Annual GEM conference, the network members worked with a team of facilitators from Health Quality Ontario to explore core GEM processes in three areas: How do patients get to GEM, what happens when they get there and what happens afterwards. To inform this quality exploration an online GEM practice survey was completed by 61% of presently active GEM nurses from 10 LHINs. The present poster presents background on GEM together with some preliminary results from the GEM Practice Survey and process maps in the three areas of GEM practice. The GEM nursing network was initiated by the Regional Geriatric Programs (RGPs) of Ontario and is coordinated by the RGP of Toronto. For additional information please contact: Kerri Fisher, Coordinator Regional Geriatric Program of Toronto Email: kerri.fishersunnybrook.ca Telephone: 416.480.5881 UNIQUE VULNERABILITIES OF FRAIL SENIORS  Symptom presentation is complex and atypical  Multiple co-occurring illness  Poly-pharmacy is the rule not the exception  Diagnostic tests may have normal value  Functional/compensatory reserves are limited  Psychosocial circumstances are changing  Support systems are stretched  Risk of hospitalization is high  Capacity for independent living is threatened  Determine level of risk  Assess and clarify elements of frailty  Identify geriatric syndromes  Clarify atypical presentations  Guide appropriate resource utilization  Inform care coordinators and health system planners  Communicate concerns to other stakeholders (geriatric services, family physician, community services, long- term care home)  Identification of seniors at risk in the Emergency Department (ED)  Timely, targeted, essential and accurate assessments  Identification of geriatric syndromes  Screening of functional ability  Optimize linkage with community supports  Appropriate referral and disposition  Reduced admission and re-visits to ED and/or hospital  Prevent delirium and functional decline during the ED visit  Enhanced patient safety  Build geriatric capacity throughout the ED  Adapt GEM practices to best meet local needs and services GOALS OF GEM PROGRAM FACTS ABOUT GEM References: Meldon SW, Mion LC, Palmer RM et al. A brief risk-stratification tool to predict repeat ED visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med. 2003;10(3):224-32 RGPs of Ontario GEM Progress Report 04-05 www.rgps.on.ca Central East LHIN GEM Program Poster was developed by Dr. David Ryan from the resources of the Regional Geriatric Program of Toronto and the Ontario GEM Nurse Network A Network of 60 Hospitals in 13 LHINS across Ontario THE GEM PROCESS MODELING ASSISTED BY HQO RANK ORDERING OF THE PRESENTING PROBLEMS OF PATIENTS SEEN BY GEM BETTER HEALTH OUTCOMES : SERVICE, ADVOCACY, RESEARCH AND EDUCATION SERVICES AVAILABLE AT GEM HOSPITALS USAGE RATES FOR EIGHT GERIATRIC ASSESSMENT TOOLS  Distributed matrix program management model  Collaborative program rollout  Team development, training and mentorship  Linkage with the Nurse Led Outreach Teams and GAIN Clinics in various LHINS  Implementation of a common basic GEM model  Empowerment of adaptations to meet local needs  Routine risk screening  Targeted assessment  Capacity Building within EDs, hospitals, CCACs, Community Service Agencies and Long-Term Care  Routine outcome and user satisfaction evaluations BENEFITS OF ASSESSMENT SATISFACTION SURVEY RESULTS OF GEM SERVICES Item 8