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A day in the life of GEM nurses

 
Gem Nurses

GEM nurses Joy Moors (back left) and Laura Wilding (back right) attend handover rounds in the Emergency Department before assessing high-risk older adults.

As Geriatric Emergency Management (GEM) nurses, we start our day by attending handover rounds in the Emergency Department to review cases and look for appropriate referrals.  We then prioritize, determining which of our older patients are at highest risk for poor outcomes or returning to the ED.

Then we start seeing patients and completing our specialized geriatric assessments. A sprained ankle in a 19-year-old is not the same as in a 90-year-old. Geriatric patients have complex medical needs that are different from younger people, with other factors that need to be considered. Do they have issues with cognition, multiple medications, pain, mobility or functional concerns that may affect our ED care? We look at the big picture and then work with the ED team to develop a comprehensive plan of care.

Most of our patients haven’t been seen by geriatrics before, and many end up in the ED when things start to go wrong. By completing our assessments in the ED, and linking them with geriatric services, they get treatment earlier and are less likely to decline. If we send that 90-year-old home when she can’t walk and her medications are wrong, she may return to the ED in worse shape, perhaps with a broken hip or a delirium. We help keep patients where they want to be – safe, and independent at home.

In the afternoon, with another GEM nurse on shift, we complete more assessments, follow up with complex cases and do telephone assessments for patients who were stable enough to be sent home after hours. We talk to our various community partners about referrals. And we also promote education, research and evidence-based practice to help build a senior-friendly ED.

TOH has the largest GEM program in North America. Our 11 GEM nurses are all ED nurses with specialized geriatric training, including an Advanced Practice Nurse who manages the corporate program. GEM nurses are improving flow through the ED, and reducing repeat ED visits and admissions to hospital, which translates into big savings.

By Joy Moors, Jennifer Koop and Laura Wilding

Geriatric Emergency Management, by the numbers:

  • 3,000 – patients seen per year
  • 11% – lower admission rate when patients are seen by GEM
  • $1.9 million – savings for TOH in 2012—2013
  • 30 – service-level agreements with community partners (specialized geriatric clinics, geriatric outreach teams, geriatric psychiatry and more)
 
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