Resources for Nurses Caring for Older Patients in the ED
Original abstract presented at ENA 2024:
Title: Lessons Learned from Leveraging Nurse Champions in Geriatric Emergency Departments
Purpose: Older adults utilize the emergency department (ED) more frequently than younger adults, often with clinical and social needs that impact care. To improve identification of patient vulnerabilities and standardize care, hospitals have begun implementing the geriatric emergency department (GED) model. Accreditation requirements for gold and silver level GEDs established the role of a nurse champion to support care process development, nurse education, and implementation of geriatric protocols. Accreditation criteria provide deliberately broad guidelines, permitting each site to tailor the nurse champion role to their operational needs. This study sought to describe and learn from the implementation of the nurse champion role in five gold level GEDs. Most participating sites referred to this role as a Geriatric Emergency Nurse Initiative Expert (GENIE).
Design: This was a mixed methods operational study that assessed variation in GED implementation across five Level 1 EDs within a large health system.
Sample: Nine clinical champions including four physicians, four GENIEs, and one advanced practice provider.
Setting: Five GED-accredited academic medical center EDs.
Methods: A semi-structured interview guide was developed and piloted to obtain information about GED implementation, including facilitators and barriers. Interviews were conducted in person with follow-up by Zoom. Results were synthesized to identify common themes across sites, tailoring strategies, and contextual factors contributing to variation in implementation. Information extracted about the nurse champion role was synthesized and is the focus of this analysis.
Results: All five sites are academic medical centers in large metropolitan areas with annual censuses between 40,000 to 76,000 encounters. The share of 65+ ED patients range from 22% to 31%. During implementation, champions highlighted the time-intensive process required for scaling up the GENIE role, which was impeded by a lack of role specificity. Once established, clinical champions described the role’s utility as a “force multiplier,” with GENIEs maximizing their impact through non-clinical work to engage and educate staff. This included developing and disseminating educational materials and reinforcing staff efforts. Non-clinical activities beyond the ED included peer learning from other geriatrics providers, gathering information about other programs within their hospital and community, and aligning GED priorities with higher-level operational goals. Take-aways from facilitators and barriers encountered include the need for a “blueprint” for GENIEs’ day-to-day activities, roles, and responsibilities. Physician champions emphasized a need to prioritize and protect GENIEs’ time for GED obligations by advocating on an ongoing basis and setting clear expectations with other staff and leadership. Champions discussed struggles with workforce shortages, staff turnover, and the need to gain buy-in from travel nurses, all amplified by the COVID19 pandemic.
Resources for ED nurses interested in learning more:
For more information about Geriatric Emergency Department accreditation, visit the GED accreditation website.
The GED Collaborative (GEDC) has developed free trainings for nurses regardless of facility GED accreditation. Follow this link for a list of available resources. The GEDC is also developing a peer learning network for GED nurses, please bookmark and check back this fall for details.
The Emergency Nurses Association (ENA) are champions of geriatric emergency nursing; they’ve developed a variety of resources and offer comprehensive Geriatric Emergency Nursing Education (GENE) courses.
The Hartford Institute for Geriatric Nursing (HIGN) has developed and published evidence-based geriatric nursing best practices. These include protocols and tools to reference and implement.