Archive - August, 2013

A GEM of an idea

The Tan Tock Seng Hospital (TTSH) in Singapore first started a Geriatric Emergency Medicine (GEM) in 2006. Since that time, the hospital has introduced several initiatives with the aim of improving the delivery of care to elderly patients in the Emergency Department (ED) including risk stratification, geriatric screening, falls evaluation and bladder control. TTSH currently has four GEM subspecialist doctors, and have trained more than 50 GEM nurses in its ED. TTSH remains the only hospital with geriatric services in the ED.

Ageless Voice finds out more about GEM from Dr Foo Chik Loon from the TTSH Emergency Dept:

What’s GEM about? How did you become involved in this field of emergency medicine?

In 2006, when at a lull in my career, my head of department pulled me into her office and asked me to start a geriatric emergency service. I had no interest in the elderly then, but later came to be in awe of every geriatrician I’d met. Today, with the help of an amazing team of doctors and nurses, slowly but surely, we’ve helped a lot of ED elders.

GEM is about improving the delivery of care to the elderly patients presenting to the emergency department. Its three pillars are:

a) Education – Majority of ED doctors and nurses received minimal training in geriatric care in medical/nursing school. It is important to raise their knowledge of the unique characteristics of the elderly, such as atypical presentations, polypharmacy, cognitive impairment, chronic diseases, and psychosocial dysfunction.

b) Target & screening – The ED traditional model of care is to ‘see and dispose’, i.e. to manage the patient’s primary complaint and either admit or discharge. However, the elderly patient is far more complex than their younger counterparts. Apart from the primary complaint, there are often multiple biopsychosocial issues that are hidden, that may have contributed to the presenting complaint, and that would result in further adverse events if unaddressed. The role of GEM is to screen for and unravel these unmet needs.

c) Networking – If clinically possible, elderly patients should be kept away from hospitalisation as far as possible. Admission comes with risks of deconditioning, nosocomial infections, medication errors, etc. To provide alternatives to admission, it is necessary for ED to establish direct workflows and links social, community and stepdown services. This is currently lacking in most EDs, resulting in inadequate transition of care upon discharge from ED.

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