288Geriatric EMergency Services (GEMS): An Acute Floor Frailty Service Model

Abstract

Background: The National Clinical Programme for Older People (NCPOP) recommends early identification of frailty and early Comprehensive Geriatric Assessment (CGA)/Our aim is to improve the care, outcomes and patient experience of older people with frailty attending our hospital. Methods: A database was prospectively compiled on all patients over 75 with frailty. At triage, the Variable Indicative of Placement tool (VIP) was used to screen for frailty. This electronic screening is mandatory. Early CGA was performed by the interdisciplinary GEMS team. We collected data on case mix, process and outcomes. Using the National Quality Assurance and Improvement System (NQAIS), we compared data from pre- and post-GEMS. Results: 4,854 patients were triaged. 2,086 (43%) were screened as frail. 1,352 (65%) had a CGA. Mean time from arrival to VIP was 34 minutes and from VIP to CGA was 2.46 hours. Mean and median age was 85. 66% came from home, 19% from long term care (LTC), 4% from other care facilities. 82% were admitted into hospital. ALOS for GEMS was 9.57 days (Median = 6). On CGA, 11.6% were identified at risk of delirium (using the 4AT score). 9% were at risk of cognitive impairment (4AT). 78% were at risk of polypharmacy (>5 medications). 28% were at risk of malnutrition. 57% were discharged home. 7% were newly discharged to LTC. In-hospital mortality was 6%. 30-day re-admission rate was 11%. From NQAIS, ALOS was 6.9 days and 30-day re-admission rate was 16.5% preGEMS. Post-GEMS, ALOS was 6.7 days and re-admission rate was 15.6%. This is a reduction in ALOS by 0.2 days (p = 0.0002) and a reduction in 30-day re-admission rate by 0.9%. Conclusion: The implementation of GEMS has facilitated better identification and management of Geriatric Giants, with associated reductions in length of stay and readmissions. We recommend the GEMS Model for all acute hospital floors.