VA Geriatric Emergency Department Program (Previously GERI-VET)

Last updated 2024-03-06T21:52:37Z

National VA Geriatric Emergency Department Mission is Enhancing
geriatric-focused care in VA emergency departments throughout the nation via education, standardization, environmental enhancement, and promotion of a comprehensive care model. This initiative grew out of a pilot in at the Cleveland VAMC: Geriatric Emergency Room Interventions for Veterans (GERI-VET), an evidence-based multidisciplinary program performing geriatric screens and care coordination for at-risk older Veterans treated in the ED, was implemented based on established best practices for Geriatric ED care. ED staff receive multimodal geriatric emergency medicine training and champion the care of the most frail, older Veterans during their ED visit. Geri-Vet served as a platform for Geriatric ED Accreditation through the American College of Emergency Physicians.

Origin:

December 2016, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio)

Adoptions:

68 successful, 22 in-progress

Awards and Recognition:

Diffusion of Excellence Promising Practice, American College of Emergency Medicine Accredited Health System Geriatric Emergency Department

Partners:

Diffusion of Excellence, Emergency Medicine, Geriatrics and Extended Care, Office of Rural Health, VHA Innovators Network

Overview

The problem

In 2016, there were 1,051,597 Emergency Department (ED) visits for Veterans 65 and older within Veterans Health Administration (VHA). Traditionally, ED and primary care providers have received little formal training in geriatric assessment and management of geriatric syndromes. As a result, ED visits for older adults focus on the treatment of presenting emer ... In 2016, there were 1,051,597 Emergency Department (ED) visits for Veterans 65 and older within Veterans Health Administration (VHA). Traditionally, ED and primary care providers have received little formal training in geriatric assessment and management of geriatric syndromes. As a result, ED visits for older adults focus on the treatment of presenting emergent conditions, rather than addressing underlying geriatric syndromes and subsequent care coordination. ED visits are a missed opportunity to optimize patient care for older adults by recognizing the root cause of presentation, preventing further functional decline, and decreasing ED revisits or hospital admissions. See more

The solution

With the aim of providing comprehensive, geriatric-focused care, Louis Stokes Cleveland VAMC initiated their geriatric emergency department (GED) program in December 2016. The objectives of the program include:

-Detecting unrecognized geriatric syndromes for older Veterans in the ED (age 65+)
-Providing evidence-based emergency care for age-specific need ... With the aim of providing comprehensive, geriatric-focused care, Louis Stokes Cleveland VAMC initiated their geriatric emergency department (GED) program in December 2016. The objectives of the program include:

-Detecting unrecognized geriatric syndromes for older Veterans in the ED (age 65+)
-Providing evidence-based emergency care for age-specific needs
-Ensuring comprehensive care coordination and timely referrals for VA and community resources
-Providing training for ED staff to champion this care See more

Files

Diffusion of Excellence GED Practice Overview Geriatric ED Summary

Links

VA news VA Program Reunited 90-year old Veteran with Spouse

Press release VA Launches Program to Improve Emergency Care for Nation’s Older Veterans

Innovation New Emergency Room Initiative VA North Texas

The results

When compared to a matched control group, patients seen by Louis Stokes Cleveland VA Medical Center Geriatric Emergency Department (GED) program staff experienced a 7.4% lower rate of admission from the ED (50.1% vs. 57.5%) and a 7.2% lower 30-day admission rate (56.8% vs 64). This translates to a 30 day estimated cost avoidance savings of $2,216 per Veteran ... When compared to a matched control group, patients seen by Louis Stokes Cleveland VA Medical Center Geriatric Emergency Department (GED) program staff experienced a 7.4% lower rate of admission from the ED (50.1% vs. 57.5%) and a 7.2% lower 30-day admission rate (56.8% vs 64). This translates to a 30 day estimated cost avoidance savings of $2,216 per Veteran served by the GED program team and 237 bed days per year (based on facility 2019 average medical admission cost and length of stay for patients age 65+ and estimated 2019 salary support (Washington DC locality rate)). GED program patients underwent evaluation by Pharmacy (43%), Social Work (55%), Physical Therapy (3%) while in the ED. Durable medical equipment was provided to 7%. Additionally, referral rates for VA home and community resources were notably higher for GED patients upon discharge from the ED. An examination of screening data indicated a significant prevalence of geriatric syndromes, as well as caregiver burden. Moreover, nearly 60% of GED program patients were determined to be at significant risk of falling. See more

Images

Above:

Estimated Cost Avoidance Savings based on program analysis of Louis Stokes Cleveland VAMC Geriatric Emergency Department Program (2019 data)

Links

Outcomes paper Association of a geriatric emergency department program with healthcare outcomes among Veterans

Feasibility paper Implementation of a geriatric emergency department program using a novel workforce

Innovation paper Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool

Innovation Paper Integrating physical therapy into an emergency department: A clinical pilot program

Geriatric ED enterprise wide spread Dissemination and implementation of age-friendly care and geriatric emergency department accreditation at Veterans Affairs hospitals

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

AR: John L. McClellan Memorial Veterans' Hospital (Little Rock, Arkansas) CA: Sacramento VA Medical Center (Sacramento) DE: Wilmington VA Medical Center (Wilmington, Delaware) FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami) FL: Lake City VA Medical Center (Lake City, Florida) FL: Orlando VA Medical Center (Orlando) IA: Iowa City VA Medical Center (Iowa City, Iowa) IL: Edward Hines Junior Hospital (Hines) IN: Fort Wayne VA Medical Center (Fort Wayne) KS: Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth) KY: Troy Bowling Campus (Lexington-Cooper) MN: Minneapolis VA Medical Center (Minneapolis, Minnesota) MS: Biloxi VA Medical Center (Biloxi) ND: Fargo VA Medical Center (Fargo) OK: Oklahoma City VA Medical Center (Oklahoma City) OR: Portland VA Medical Center (Portland, Oregon) PA: Wilkes-Barre VA Medical Center (Wilkes-Barre) SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls) TN: Memphis VA Medical Center (Memphis) TX: Thomas E. Creek Department of Veterans Affairs Medical Center (Amarillo) VA: Hampton VA Medical Center (Hampton) WV: Martinsburg VA Medical Center (Martinsburg)

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

Above:

Veteran being assessed for physical, psychological, and social factors that impact the older Veterans’ overall health.

Above:

Geriatric ED group engages others to works collaboratively to ensure proper measures are in place to treat all Veteran and caregiver needs upon discharge from the ED

Above:

Geriatric ED training through in person boot camps (online training also available)

Videos

Above:

Dr. Todd Smith discusses the Geriatric ED program for the 2018 VA Innovation Experience

Implementation

Timeline

Month 1

Identify Geriatric ED champions
Months 1-3

Multimodal geriatric ED education for ED staff
Months 1-3

Build Geriatric ED documentation in CPRS (National Template, GERIATRIC ED NOTE TEMPLATE, must be used per Emergency Medicine Memo if performing the following screens: Identifying Seniors at Risk, Delirium Triage Screen, Brief Confusion Assessment Method, Mini-Cog, STopping Elderly Accidents Death and Injury (STEADI), Katz Activities of Daily Living, Zarit Caregiver Burden 4-Question)
Month 1-3

Socialize your program with related VA departments and services (eg Geriatrics, Primary Care, Physical and Occupational Therapy, Prosthetics, Pharmacy, Mental Health, Homecare, Telehealth, Social Work)
Month 3-6

Initiate geriatric screens and care coordination
Month 6-9

Apply for Geriatric ED Accreditation through the American College of Emergency Physicians
Month 6-Sustainment

Plan-Do-Study-Act continuous quality improvement

Departments

Social work
Emergency care
Pharmacy
Geriatrics
Caregiver support
Education and training

Core Resources

Resource type	Resource description
PEOPLE	Physician Champion (Board Certified in EM) Nurse Champion

Files

flyer Cleveland Geriatric ED Accreditation Flyer

Links

Internal VA Sharepoint National VA Geriatric ED

Journal of Geriatric Emergency Medicine Intermediate Care Technicians-A Novel Workforce for Veterans Affairs Geriatric Emergency Departments

Optional Resources

Links

Press release on National Collaboration to Promote Geriatric Emergency Medicine Care throughout the VA VA Enhances Geriatric Emergency Care for Older Veterans

Press release 2023 Accredited Geriatric Emergency Departments Continue to Grow Within VA Hospitals

Special Issue on Veteran Emergency Care April 2023 Academic Emergency Medicine Volume 30, Issue 4

VA News article on the spread of geriatric emergency medicine within the VA VA emergency departments ready for growing population of older Veterans

Risks and mitigations

Risk	Mitigation
Detection of acute geriatric syndromes warranting follow-up.	Provide education on geriatric care plans and VA resources to multidisciplinary ED staff.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email VHAGEDCoreTeam@va.gov with questions about this innovation.

About

Origin story

Dr. Huded, Co-Director of GERI-VET, had the opportunity to participate in the multisite GEDI WISE program at Northwestern Memorial Hospital during her Geriatric fellowship. Wanting to bring a similar evidence-based model of Geriatric ED care to the VHA, she initiated GERI-VET in 2016 with the support of the Cleveland GRECC and VA Innovators Network. GERI-V ... Dr. Huded, Co-Director of GERI-VET, had the opportunity to participate in the multisite GEDI WISE program at Northwestern Memorial Hospital during her Geriatric fellowship. Wanting to bring a similar evidence-based model of Geriatric ED care to the VHA, she initiated GERI-VET in 2016 with the support of the Cleveland GRECC and VA Innovators Network. GERI-VET has worked with over a dozen sites in 2018 and 2019 interested in similar programming. In 2019, the VA Emergency Medicine Office in partnership with the Office of Geriatrics and Extended Care launched a nationwide spread of Geriatric Emergency Medicine with a goal of enterprise wide participation by 2026.

Original team

Dr. Robert Bonomo/Director of Cleveland GRECC

Dr. Chad Kessler/National Director of Emergency Medicine

Dr. Tom Edes/Director of Comprehensive Geriatrics & Palliative Care Clinical Operations

Dr. Jill Huded

Founder

Dr. Colleen McQuown

Director, Geriatric Emergency Medicine, Louis Stokes Cleveland VA Medical Center

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VA Geriatric Emergency Department Program (Previously GERI-VET)

Origin:

Adoptions:

Awards and Recognition:

Partners:

CATEGORIES:

Overview

The problem

The solution

Files

Links

The results

Images

Above:

Links

Diffusion tracker

Successful adoptions (68)

In-progress adoptions (22)

Unsuccessful adoptions (0)

Multimedia

Images

Above:

Above:

Above:

Videos

Above:

Implementation

Timeline

Month 1

Months 1-3

Months 1-3

Month 1-3

Month 3-6

Month 6-9

Month 6-Sustainment

Departments

Core Resources

PEOPLE

Files

Links

Optional Resources

Links

Risks and mitigations

Contact

Comment

Email

About

Origin story

Original team

Search categories