GERIATRIC EMERGENCY SERVICES (GEMS): AN ACUTE FLOOR FRAILTY SERVICE MODEL

Abstract Ref: 
0288

Aoife McFeely, Roisin Corcoran, Kristina Jusmanova, Rachel Kearns, Ellen Marks,
Louise Ward, Shauna O’Brien, Olga Fagan, Melinda Nugent, Orla O’Dwyer, Kate Jackson,
Sidique Arif, Ciaran Cronin, Danielle Reddy, Helen Fitzgerald, Maureen O’Callaghan,
Megan Hayes Brennan, Jane Nolan, Emer Ahern

St Luke’s Hospital, Kilkenny, Ireland

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% pre-
GEMS. 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.