Specialized Emergency Care for Frailty

Overseen By Scott Dresden, MD MS

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Disqualifiers: Covid-19, English language, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: Immediate (during ED visit)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new approach to emergency care for older adults at Northwestern Memorial Hospital. It aims to determine if adding a specialized team, the Geriatric Emergency Department Innovations (GEDI) team, can enhance care for frail older patients. Participants will be divided into two groups: one will receive standard emergency care plus GEDI team attention, while the other will receive only standard care. The trial seeks participants who are 65 or older, live in the community, and experience noticeable frailty affecting daily life. As an unphased trial, this study offers a unique opportunity to contribute to innovative care improvements for older adults.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the GEDI program is safe for older adults in emergency care?

Research has shown that the Geriatric Emergency Department Innovations (GEDI) program has been studied for its effects on older adults in emergency care. These studies examined whether the program affects hospitalization or mortality rates within 30 days after an emergency visit. The findings indicate that the GEDI program does not increase these risks compared to regular care, suggesting it is well-tolerated by patients.

The GEDI program is specifically designed to meet the unique needs of older adults, making emergency visits safer and more effective for them. It employs specialized care practices without introducing new medications or invasive procedures. Therefore, it presents no additional safety concerns beyond those typical in emergency care. This demonstrates that the GEDI program is a safe option for older adults who need emergency care. ^{1 2 3 4 5}

Why are researchers excited about this trial?

The Geriatric Emergency Department Innovations (GEDI) program is unique because it adds a specialized geriatric consult to standard emergency care, aiming to better address the needs of frail elderly patients. Unlike typical emergency care that focuses on immediate medical issues, GEDI incorporates a holistic approach that considers the overall health and social needs of older adults. Researchers are excited about this approach because it has the potential to improve patient outcomes by reducing hospital readmissions and enhancing the quality of care for frail seniors. This patient-centered strategy could lead to more tailored and effective treatment plans for one of the most vulnerable populations in emergency settings.

What evidence suggests that the GEDI program is effective for frailty in emergency care?

Research has shown that the Geriatric Emergency Department Innovations (GEDI) program, which participants in this trial may receive, might reduce the number of older adults needing hospital stays after emergency room visits. Studies have found that the GEDI program can lower hospital admissions for older patients. Evidence also suggests that GEDI could save money for hospitals and insurance companies by reducing unnecessary hospital stays. However, more research is needed to confirm these benefits. Overall, early results are promising for improving emergency care for older adults. ^{1 4 6 7 8}

Who Is on the Research Team?

Scott M Dresden, MD, MS

Principal Investigator

Northwestern University Department of Emergency Medicine

Are You a Good Fit for This Trial?

This trial is for older adults aged 65 or above who are living independently or with others, can provide informed consent, and have a Clinical Frailty Scale score of at least 4. It's not for those in critical condition, non-urgent cases, enrolled in another study, unable to follow-up or complete assessments in English, COVID-19 positive patients, prisoners, psychiatric holds or if they've had certain consultations outside the trial.

Inclusion Criteria

I am 65 or older and was a patient at the Northwestern Emergency Department.

Northwestern Emergency Department patients with a Clinical Frailty Scale (CFS) score of 4 or greater

Northwestern Emergency Department patients who are living independently or with friends, family, or caregivers in the community

Exclusion Criteria

Patients who are admitted to the ICU

Patients who are too medically unstable to participate in the assessment

I cannot complete assessments in English.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive care in the emergency department with or without the GEDI program

Immediate (during ED visit)

1 visit (in-person)

Follow-up

Participants are monitored for health outcomes and quality of life measures

30 days

Follow-up assessments (virtual or in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Geriatric Emergency Department Innovations (GEDI) program

Trial Overview The study tests the Geriatric Emergency Department Innovations (GEDI) program. Participants will either receive care from a standard emergency department team plus GEDI specialists or just the usual emergency care. The aim is to see if adding GEDI improves outcomes for frail older adults.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

Standard emergency department are plus GEDI consult

Group II: Control Active Control 1 Intervention

Standard emergency department care

Geriatric Emergency Department Innovations (GEDI) program is already approved in United States for the following indications:

Approved in United States as GEDI for:

• Emergency department care for older adults

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

Published Research Related to This Trial

The Geriatric Emergency Department Intervention (GEDI) model significantly improved the likelihood of safe discharge for residents of residential aged care facilities (RACFs) in the emergency department, with a hazard ratio of 1.15, indicating a 15% increase in discharge rates after implementation.

The GEDI model also reduced the length of stay in the emergency department by 49%, with a hazard ratio of 1.49, demonstrating its effectiveness in optimizing care for frail older adults without increasing mortality or re-presentation rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non-randomised trial. Marsden, E., Taylor, A., Wallis, M., et al.[2021]

The Geriatric Emergency Department Intervention (GEDI) improved healthcare outcomes for older adults (70 years and over) by increasing the likelihood of discharge and reducing emergency department length of stay and hospital costs, as shown in a study across two Australian hospitals.

The intervention also correlated with a reduced risk of in-hospital mortality within 28 days, demonstrating its effectiveness in managing frail older adults in emergency settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Translation of the geriatric emergency department intervention into other emergency departments: a post implementation evaluation of outcomes for older adults. Marsden, E., Craswell, A., Taylor, A., et al.[2022]

The study analyzed 128,050 emergency department patients aged over 65 to develop machine learning models that accurately predict hospital admissions, achieving a strong performance with an area under the curve of 0.774.

The models indicated that only 2.7% of patients would have a change in their hospital disposition with GEDI assessment, suggesting that targeted use of GEDI care could effectively reduce unnecessary hospitalizations for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Machine Learning to Predict Hospital Disposition With Geriatric Emergency Department Innovation Intervention. Bunney, G., Tran, S., Han, S., et al.[2023]

The Geriatric Emergency Department Intervention (GEDI) model is effective in improving outcomes for frail older adults, highlighting the need for specific structures like experienced geriatric nurses and physician champions for successful implementation.

Key processes for the GEDI model include a patient-centered approach and strong communication skills among staff, which are essential for addressing the unique care needs of the aging population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A structure and process evaluation of the Geriatric Emergency Department Intervention model. Marsden, EJ., Taylor, A., Wallis, M., et al.[2021]

The Geriatric Emergency Department Intervention (GEDI) model was successfully implemented in two hospitals to improve care for frail older adults in the emergency department, with support from the i-PARIHS framework guiding the process.

Despite challenges such as resource limitations and changes in context, dedicated clinicians adapted the GEDI model to fit their specific needs, demonstrating the model's flexibility and effectiveness in managing frail older patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. Wallis, M., Craswell, A., Marsden, E., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11567090/

The impact of Geriatric Emergency Department Innovations ... Observational studies suggest GEDI is associated with decreases in hospitalizations for older adults, however current research is limited and has not ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/32858227/

The impact of Geriatric Emergency Department Innovations ... The objective of this randomized controlled trial (RCT) is to evaluate the efficacy of the Geriatric Emergency Department Innovations (GEDI) program.

3. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2776803

Geriatric ED Innovation Program and Cost Outcomes ... These findings suggest that geriatric emergency department care programs may be associated with savings value to hospitals and payers.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1551714420302032

The impact of Geriatric Emergency Department Innovations ... Observational studies suggest GEDI is associated with decreases in hospitalizations for older adults, however current research is limited and has not ...

5. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-02999-4

a post implementation evaluation of outcomes for older adults This quantitative cohort study aimed to evaluate the healthcare outcomes and costs associated with the implementation of the Geriatric Emergency ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12476112/

The Geriatric Emergency Department Guidelines 2.0 - PMC The process, experience, and outcomes of emergency care for older adults are uniquely complex due to geriatric syndromes, multimorbidity ...

7. agsjournals.onlinelibrary.wiley.com agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.12979

Geriatric Emergency Department Innovations: Preliminary ... GEDI consultation was available Monday through Friday from 9:00 a.m. to 8:00 p.m. An extensive database was set up to collect clinical outcomes ...

8. annemergmed.com annemergmed.com/article/S0196-0644(13)01112-8/fulltext

GEDI WISE: Geriatric Emergency Department Innovations ... GEDI WISE is an innovative shift in the paradigm of ED care for older adults. The impact of this new care model on health care outcomes for older adult patients ...