REGIONAL GERIATRIC ASSESSMENT PROGRAM OF OTTAWA

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• REGIONAL GERIATRIC ASSESSMENT PROGRAM OF OTTAWA

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GERIATRIC EMERGENCY MANAGEMENT PROGRAM

• May 24, 2002

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BACKGROUND

• GEM identified as a priority by Regional
  Geriatric Assessment Program 1999
• RGAP clinical umbrella
• Steering Committee struck 1999
• Final proposal submitted 2000
• Implementation/planning began summer 2001

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GENERIC GEM PROCESS
Initial Screen By Triage RN

Page GEM Assessor
Appropriate?
Yes
Patient assessment By Gem Assessor
Patient meets Criteria?
Discharge plan begun
No
Yes
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KEY COMPONENTS TO ADDRESS WITH EACH ORGANISATION

• Identification of potential GEM clients and
  communication with GEM assessor
• 7 day clinical follow-up
• Provision of important information to intake
  clerk
• Education of ED staff regarding GEM program

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FACILITATING FORCES

• Geriatric training for GEM assessors
• Ownership of program by each hospitals
  management, the EDs management and the ED staff
• Negotiations with referrals sites
• Involvement by the geriatric teams
  (geriatricians, nurses and allied health) in the
  planning and implementation
• Capacity of specialized geriatric services

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FACILITATING FORCES

• 7. Administrative champions
• Pre-determined process evaluation criteria
• Development of a concise GEM assessment tool
• Minimize GEM assessor coordination activities

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NEGATIVE FORCES

• ED environment
• ED workload

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EVOLVING MODELS OF IMPLEMENTATION

• 3 models evolved each with varying degrees of
  success
• Integration without prioritizing GEM role
• Integration with significant prioritization of
  GEM role
• Resource dedication

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OBSERVATIONS

• Admission of patients following GEM assessment
• ISAR 2 and 75 ? too restrictive?
• Enhanced geriatric awareness in the ED
• GEM patients referred to community services
  significantly acute
• Administration of ISAR?

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SPIN-OFFS

• Increased community referrals from ED
• ?Outreach referrals increased by 300
• 2. Enhanced geriatric skills and knowledge