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)

822 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Geriatric Emergency Department Innovations (GEDI) program?

The GEDI program has been shown to improve health outcomes for frail older adults in emergency departments by reducing preventable hospital admissions and optimizing care, especially for those from aged care facilities. ^{1 2 3 4 5}

Is the Geriatric Emergency Department Intervention (GEDI) safe for humans?

The Geriatric Emergency Department Intervention (GEDI) model is designed to improve care for frail older adults in emergency departments, and while the studies focus on its effectiveness, they do not report any specific safety concerns for humans. ^{1 2 3 4 5}

How is the Geriatric Emergency Department Innovations (GEDI) treatment different from other treatments for frailty?

The GEDI treatment is unique because it is a nurse-led program specifically designed to provide targeted care and coordination for frail older adults in emergency departments, aiming to reduce preventable hospital admissions and improve health outcomes. ^{1 2 3 4 5}

What is the purpose of this trial?

This study evaluates the Geriatric Emergency Department Innovations (GEDI) program at Northwestern Memorial Hospital to care for older adults in the emergency department. Half of the patients will be cared for by a standard ED team plus the GEDI team, while half of the patients will receive usual ED care.

Research Team

Scott M Dresden, MD, MS

Principal Investigator

Northwestern University Department of Emergency Medicine

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 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]

References

1. England pubmed.ncbi.nlm.nih.gov

Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. [2023]

2. Australia pubmed.ncbi.nlm.nih.gov

A structure and process evaluation of the Geriatric Emergency Department Intervention model. [2021]

3. Australia 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. [2021]

4. England 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. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Using Machine Learning to Predict Hospital Disposition With Geriatric Emergency Department Innovation Intervention. [2023]