The Impact of the Geriatric Emergency Department Initiative on Older Community Dwelling Adults Presenting to the Emergency Department With a Completed Delirium Screen

Abstract

Objective: Australia's ageing population resulted in increasing Emergency Department (ED) presentations among older adults, particularly frail and those at risk of adverse outcomes. Delirium contributes significantly to morbidity in this cohort. The 4AT screening tool is routinely employed to identify risk. This study examined the impact of the Geriatric Emergency Department Initiative (GEDI) on clinical outcomes for older community dwelling adults presenting to ED with a completed 4AT. Methods: A retrospective, single-centre observational cohort study was conducted at an urban district ED. Patients ≥ 75 years, and First Nations peoples ≥ 55 years, with a completed 4AT presenting between January 1 and June 30, 2023 were included. Data were extracted and analysed using descriptive and comparative statistics. Results: Of 1756 patients, 918 (52%) received GEDI input. Overall, 1135 (65%) had a 4AT score of 0 (no cognitive impairment), 410 (23%) with 4AT of 1–3 (mild cognitive impairment), and 211 (12%) with 4AT score of ≥ 4 (probable delirium). Among patients with a 4AT of 0, GEDI involvement was associated with shorter ED lengths of stay, lower admission rates, and higher discharges home (all p < 0.001). Patients with 4AT scores 1–3, GEDI involvement lowered admission rates, increased discharges home, with no difference in ED length of stay. No significant differences were observed with 4AT scores ≥ 4 when compared to standard care. Conclusions: GEDI involvement reduced ED length of stay and admission rates among older adults without delirium or with mild cognitive impairment, but no significant impact was observed for patients with probable delirium.