Integrating comprehensive geriatric care into emergency departments: the GIROT-ED model

Older adults account for a substantial proportion of emergency department (ED) visits, yet standard care models often fail to address their complex needs. We describe the organization and short-term outcomes of the GIROT-ED model (Gruppo Intervento Rapido Ospedale Territorio), an ED-integrated geriatric service in Florence, Italy. A retrospective observational study was conducted, including older ED patients with disability and/or moderate-to-severe dementia evaluated by the GIROT-ED service in three EDs (January 2023-December 2024) and considered for admission. Available individualized care pathways included home discharge with hospital-at-home (HaH), intermediate care, or hospital admission. Process indicators (time to first medical evaluation, ED length of stay, and 24- and 72-h revisits) and 72-h mortality were described; multivariable logistic regression identified predictors of home discharge. Among 8113 patients (median age 88 years; 62% female), 63% were discharged home with HaH, 14% were referred to intermediate care, and 22% were admitted; 0.9% died in the ED. Revisits were 1.6% at 24 h and 3.4% at 72 h; 72-h mortality was 3.8%. Increasing age was associated with higher odds of home discharge (OR per year 1.03, 95%CI 1.02-1.04), whereas male sex (OR 0.73, 95%CI 0.69-0.87) and longer ED length of stay (OR per minute 0.99, p < 0.001) were associated with lower odds. In this large real-world cohort, the GIROT-ED model was associated with high rates of home discharge supported by hospital-at-home services and low short-term revisit rates. Given the observational design, these findings should be interpreted cautiously. Further studies are needed to assess long-term outcomes and cost-effectiveness.