Quantitative Evaluation of the Geriatric Emergency Department Innovation ( GEDI ). An Interrupted Time Series Study

BACKGROUND: The population aged over 75 is the fastest growing demographic presenting to the emergency department (ED). Various ED models have been implemented to address the needs of older patients, including care coordination and dedicated care zones. We describe the impact of the Geriatric Emergency Department Innovation (GEDI) with the aim of evaluating the proportion of older patients not admitted to hospital. Secondary outcomes of interest were ED length of stay (EDLOS), rate of admission to the secondary (Repatriation) campus, short stay unit (SSU) utilization, and re-presentation rates. METHOD: This single site study at a quaternary hospital with a main (Austin) campus and a secondary (Repatriation) campus employed interrupted time series analysis to assess the impact of GEDI while accounting for temporal trends. RESULTS: Before the introduction of GEDI, the rate of nonadmission of older patients to hospital was increasing by 0.1% per month (monthly change 1.001, 5% CI: 0.999, 1.002). After GEDI Implementation, this rate increased by 1.2% per month (1.012; 95% CI: 1.004, 1.020). The EDLOS increased by 0.08 (95% CI: 0.062, 0.099) hours per month prior to GEDI but then reduced by 0.207 (95% CI: -0.344, -0.069) hours per month afterwards. SSU utilization, re-presentations, and admissions to the Repatriation campus did not adversely change after GEDI introduction. CONCLUSION: The introduction of GEDI reduced EDLOS and inpatient admissions in older patients. Further research on economic benefit, patient-related outcome, and experience measures are needed to further evaluate the success of this program.