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Evaluating implementation of a geriatrician-led emergency department model of care: a qualitative study using the
Celene Y L Yap1,2,3, Cilla J Haywood4,5, Sanka Amadoru6,7,8,9
1Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 157-159 Barry Street, Victoria, 3010, Australia. yen.yap@unimelb.edu.au.
Purpose:
To examine determinants of adoption, workflow integration, and sustainability of an embedded geriatrician-led model of care (Geriatric Emergency Department Innovation, GEDI), a service providing timely specialist geriatric assessment for older adults presenting to the ED.
Methods:
Sixteen interviews and five focus groups were conducted, guided by semi-structured interview guides. Thirty-one participants participated, including emergency physicians (n = 5), emergency department (ED) nurse unit managers (n = 4), geriatricians (n = 5), ED pharmacists (n = 5), care coordinators (n = 8), and admitting physicians (n = 4). Interviews were audio recorded, professionally transcribed and analyzed using deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR).
Results:
Determinants of implementation were identified across CFIR domains. GEDI was perceived to offer timely specialist geriatric expertise at the bedside, supporting rapid and holistic assessment, shared decision making and collaborative practice. Adoption was hindered by inconsistent awareness among rotating junior doctors and variable staffing that affected referrals. Workflow integration was challenged by the impracticality of standardized referral criteria in a highly variable ED environment. Sustainability was threatened by referral noise when the scope was unclear, early deferral referrals were made before basic assessment, and the limited capacity of a single geriatrician to meet demand.
Conclusions:
A geriatrician-led model of care can be integrated into routine ED workflows when supported by accessible specialist expertise and collaborative interprofessional relationships. Implementation was influenced by contextual and organizational determinants across CFIR domains, suggesting that adoption in other settings will require local adaptation. Role clarity, referral processes, orientation of rotating clinicians and service capacity are central considerations for sustainability.
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