The Impact of a Geriatric Multidisciplinary Team in the Emergency Department

The Integration of a Geriatric Multidisciplinary Team (Geri MDT) in the Emergency Department

The care of geriatric patients frequently involves members of the multidisciplinary care team, including both primary medical staff and allied health professionals. Often, members of the multidisciplinary care team are mobilized after geriatric patients have presented to the emergency department and have been seen by a doctor. Mobilizing these resources sequentially in inefficient and can lead to delays in geriatric patients receiving holistic care early following their presentation to the emergency department. The goal of this observational study is to assess the impact of having a geriatric-focused multidisciplinary team (Geri-MDT) dedicated to the emergency department that can be mobilized easily and in parallel at the time of presentation. The main questions we hope to answer in this study are:

• Does the Geri-MDT increase care efficiency by reducing the amount of time patients spend in the ED?
• Does the Geri-MDT decrease the proportion of patients that are ultimately admitted to the hospital?
• When patients are admitted, does the Geri-MDT reduce the length of stay in hospital?

Older adults represent a growing proportion of the population and frequently present to hospitals with complex medical, cognitive, functional, and psychosocial needs that require interdisciplinary management. They are also at heightened risk of functional decline when accessing health services, with delays in care coordination contributing to unnecessary hospitalizations and hospitalization-associated disability. Improving outcomes for this population requires proactive, collaborative mobilization of multidisciplinary teams at the time of presentation, rather than reactive or fragmented responses. To address this need, we established a Geriatric Multidisciplinary Team (Geri-MDT) dedicated to the emergency department (ED). The Geri-MDT includes a geriatric nurse, physiotherapist, occupational therapist, social worker, and geriatrician, who together provide early triage and coordinated care for older adults presenting to the ED. We hypothesized that early, well-coordinated involvement of this team would reduce ED length of stay, decrease unnecessary admissions, and shorten inpatient admissions when required.

Inclusion criteria for the retrospective analysis were:

1. evaluation by at least one allied health professional, including a geriatric nurse, geriatrician, physiotherapist, occupational therapist, or social worker;
2. age 65 years or older; and
3. availability of the medical record in the hospital's electronic medical record (EMR) system.

Exclusion Criteria:

(1) data not available in the EMR.

In the post-implementation period, patients were flagged for Geri-MDT assessment if they met any of the following criteria:

1. age over 85 years,
2. a score of ≥4 on the Program of Research to Integrate the Services for the Maintenance of Autonomy 7 (PRISMA-7) frailty screening tool, or
3. an ED presentation related to a geriatric syndrome (e.g., fall, delirium, dementia, urinary incontinence, functional decline, or elder abuse).