Models of Nurse Led Geriatric Case Management

Main Learning Points

Dr. David Ryan at 6:30

Dr. Ryan describes the evolution of a large network of geriatric ED nurses (GEM nurses) in the province of Ontario – currently 130 nurses in 60 hospitals. He makes the point that one size does not fit all. Each site must develop a program that meets its own needs. Getting early feedback and buy-in from ED staff and decision makers is essential. He gives an overview of the many different backgrounds and training that GEM nurses have and the many different tasks that they do.

Ms. Pam Martin at 22:35

Ms. Martin reviews the many different iterations of the role that have taken place in her department – from an NP seeing only older people (functioning as a pure clinician where the geriatric principles “got left behind”) to a resource person leading the nursing team to do focussed geriatric screening. She gave several case examples to illustrate the value that nurse case management adds.

Ms. Lisa Entringer at 33:55

Ms. Entringer illustrates how geriatric case management can fit into a smaller (12-bed) rural ED.  The role grew out of senior leadership realizing that there were many complaints from older patients and families that there was inadequate support in the ED for their needs.  The Geri ED nurse now leads the interdisciplinary team to ensure enhanced screening, assessment, and appropriate follow up; and develops links to community partners.

Dr. Colleen McQuown at 45:00

Dr. McQuown describes an innovative programme within the Veterans Administration EDs to re-train field military medics to become “force multipliers” in their geriatric EDs.  She describes the training programmes for them; their workflow, triggered by the ISAR (75%) or staff concern (25%); and scripts for each of common problems that they see.  Their assessments lead to extended investigations for older patients, linkage to in-department assessments, and improved disposition plans.

Details

Goals

1. To describe strategies for establishing the role of Geriatric ED Case Management both in individual hospitals and across systems
2. To offer pragmatic tips on how to get a Geriatric ED Case Management role started, including funding and metrics for success
3. To present the range of activities performed by Case Management in the Geriatric ED and how to build it into ED workflow
4. To examine different models of Geriatric ED Case Management – large systems, community and academic settings, alternative models.

Expert Panel

David Ryan
Creator and former Director of GEM Network Regional Geriatric Program of Ontario
Pamela Martin
Program director of the Geriatric ED at Bon Secours St. Mary’s Hospital in Virginia
Lisa Entringer
Geriatric ED Nurse at Advocate Aurora Sheboygan hospital, Wisconsin
Colleen McQuown
Veterans Administration Geri VET – an alternate model using returned military medical technicians

Moderated By

Don Melady

MD

Bio

Dr. Don Melady is an emergency physician at Mount Sinai Hospital in Toronto, Canada and a founding member of the Geriatric Emergency Department Collaborative. He is the author of the website www.geri-EM.com – a CME accredited program for geriatric emergency medicine education – and the chair of the Geriatric EM committee of the International Federation of Emergency Medicine.

Geri-EM.com Geriatric-ED.com Publications