Geriatric Emergency Management (GEM) Nursing
Nearly 25% of the population of North America is poised to turn 65 within the next few decades. The demand for geriatric health care professionals, specialized care, and expanded community services is urgent. And within emergency departments, registered nurses with geriatric education are integral to managing the care of older adults.
Why GEM Nurses?
For older adults, visits to the ED are often referred to as “sentinel events”, in that they herald in a loss of independence, functional ability and general well-being. Geriatric Emergency Management (GEM) nurses can help postpone or even prevent that decline. Their experience is invaluable for assessing older patients, making appropriate care plans, communicating with other health care professionals and connecting families with services.
Familiarity with geriatric issues
GEM nurses are familiar with the complexity of older adults such as atypical presentation of disease, frailty, multi-morbidity, cognitive impairment, and polypharmacy. They use specialized screening tools to identify possible issues and barriers to safe discharge. Some of these issues can be functional, like diminished hearing/vision or loss of balance. Others may be mental, such as patients experiencing dementia or depression. They’re also able to identify social barriers, like a lack of family support or difficult living conditions and coordinate care for optimal transitions.
Frail older adults who visit the ED are more likely to have multimorbidity and take multiple medications. GEM nurses have training to address complex medical needs and medication burden.
Facilitate transitions and collaboration between geriatric health care professionals
GEM nurses aid in ensuring consistency and collaboration during a transition of care, whether within the hospital or to a skilled nursing facility, or the patient’s home. GEM nurses play an important role in helping patients access services that can increase their quality of life and provide support outside of the hospital. In many facilities, they’re involved in educating other health care personnel and developing geriatric management procedures.
Better outcomes and reduced care costs
Older adults have the highest ED use, experience high rates of revisitation, and are more likely to stay in the ED for long lengths of time. They are also more likely to be admitted and re-admitted in the future. This represents significant financial spending from both the health care system and individuals.
Evidence shows that GEM nurses reduce the need for repeated ED visits and admissions by providing specialized, individualized care. By connecting patients to supports and services outside of the hospital setting, they also decrease the likelihood of a re-visit. Training and hiring GEM nurses are an effective way to reduce healthcare costs in the short and long term – especially given staffing and budget limitations in so many hospitals and systems.
GEM Training for Nurses
Several organizations have courses for registered nurses who want or need geriatric care education. 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 Geri-EM Online modules are available through the Online Learning section at gedcollaborative.com where geriatric health care professionals can access timely modules on topics like Medication Management and Cognitive Impairment. Continuing education credits are available for nurses as well.
GEDC’s Skills Fair Modules is an online leaning platform specifically for ED clinicians, including nurses and nurse practitioners. This collection of free courses cover important topics in the treatment and management of geriatric patients.
Geriatric Emergency Management nurses are effective, cost-saving additions to emergency department personnel. They provide specialized skills that improve outcomes and patient well-being. Note that a registered nurse with geriatric emergency nursing education is also required for Geriatric Emergency Department Accreditation (GEDA).
American College of Emergency Physicians. (n.d.) Geriatric Emergency Department Accreditation. https://www.acep.org/geda
Fox, L., Holroyd-Leduc, J., Leaker, H. (2020) The Impact of Geriatric Emergency Management
Nurses on the Care of Frail Older Patients in the Emergency Department: a Systematic Review. Canadian Geriatrics Journal, 23(3), 250-256. https://doi.org/10.5770/cgj.23.408
Provincial Geriatrics Leadership Ontario. (n.d.) Geriatric Emergency Management Network (GEM). https://geriatricsontario.ca/initiatives/gem/
Sinai Health. (2019, September 24). Geriatric Emergency Management (GEM) Nurses. https://sinaigeriatrics.ca/services/mount-sinai-2/geriatric-emergency-management-nurses/
Aaron Malsch is the Senior Services Program Manager at AdvocateAuroraHealth (AAH) in Wisconsin & Illinois. He supports several geriatric models of care (NICHE, Geri ED, HELP, ACE Tracker, Geriatric Scholars). His focus is on nursing and interprofessional practice as it relates to the elder population throughout the AAH system of clinics, hospitals, emergency departments, home care services, and long term setting partners. In support of these models of care, Aaron has developed expertise in developing EHR workflow tools and reports to facilitate front line staff’s efforts and demonstrate outcomes. He leads the Geriatric ED implementation and achieved ACEP Geri ED accreditation at all AAH EDs. Aaron contributes nationally to the improvement of care for older adults, highlighted by being Chair of the geriatric committee at the Emergency Nurses Association (ENA), co-planner of GEDC symposium at the ENA conference, and reviewer of Geriatric ED Accreditation program at ACEP.