Before implementing the GEDI model, it is important that the need is identified and change management principals considered. Genuine and lasting change is sustainable when the ED staff and management at all levels realise the necessity for change and advocate for it.
Suggested steps to achieve this:
- Determine the need. Source and analyse data to determine outcomes for the cohort of older people presenting to ED. Such outcomes may include: admission and discharge rates, cost of presentation, ED length of stay (LOS) figures. Data may be obtained from the ED information system or the corporate inpatient database. This information is detailed in How to GEDI - Step 4
- Communicate findings from analysis as evidence to support the implementation of the GEDI model. NB: This may be a time-consuming process depending on the skills of staff or resources available to analyse the data.
- Utilise evidence from research such as, outcomes from the GEDI evaluative research project, to illustrate the benefits to the organisation of implementing the GEDI model.
- Prepare a business case. For suggestions on how to do this, see Example concept brief of business case pathway.
Work to do
Source ED data on presentations ≥ 75, average age and residential status (RACF or community).
Average length of time spent in ED.
Number of admitted and discharged patients from ED.
Re-presentations within 72 hours of ED discharge or 28 days of hospital admission.
Meetings
GEDI ED Physician champion to organise to meet with ED and hospital administration to present findings confirming the need for GEDI model and a risk/benefit analysis.
GEDI model pre-implementation planning
| Identify an ED physician with a passion and interest in aged care | A physician championing this initiative is crucial to the success of this project |
| Identify a Clinical Nurse Consultant (CNC) to take on the role managing the GEDI nursing team and implementation of the model | As GEDI is a nurse-led collaboration, ideally the CNC will have extensive experience in gerontology and emergency or aged care nursing and /or experience in community nursing |
| Identify and communicate the need and consider the current context | Explore the hospital clinical information system data to determine numbers of patients presenting to the ED 75 years of age and over, number of presentations from RACFs, ED length of stay, number of hospital admissions and hospital length of stay. Ensure that this model of care will complement your ED |
| Identify benefits and risks of implementation | Identify issues and measure the impact of implementing a GEDI service |
| Engage clinical and executive staff and identify key stakeholders | Clinicians and hospital management engage to discuss the possibility for funding or funding sources and identify who and how interaction will occur |
| GEDI model parameters | Determine the GEDI scope, staffing, and cost benefit ratios |
| Establish governance | Consider the work practice changes required |
