The Impact of Geriatric Emergency Management Nurses on the Care of Frail Older Patients in the Emergency Department: a Systematic Review

BACKGROUND: Frail older adults are high users of emergency departments (EDs). Many Canadian EDs have hired Geriatric Emergency Management (GEM) nurses in an effort to improve care to older adults. METHODS: We conducted a systematic review to determine the impact of GEM nurses on care provided to frail older adults. We searched MEDLINE, Embase, CINAHL, and Cochrane databases. A grey literature search was also conducted. Inclusion criteria were English-language, evaluation of GEM nurse or geriatric-trained nurse assessments of older adults (age ≥ 65 years) within the ED, and reported clinical and/or health system outcomes. The PRISMA statement was followed, and article quality was assessed using GRADE. RESULTS: 5,115 citations and 191 full text articles were screened; 8 articles from 7 different studies were included. Study quality varied between very low to high. Five included studies analyzed the effect of GEM nurses on ED revisits, with most finding they decreased revisits. Four included studies analyzed the effect of GEM nurses on hospital admissions/readmissions, demonstrating variable impact. One study looked at the cost-effectiveness and found the cost to be negligible. The impact on patient-specific outcomes was less clear. CONCLUSIONS: GEM nurses may be an effective option to help in the management of frail older adults in the ED.