Background : Older adults account for 20.3 million emergency department (ED) visits annually in the United States, representing 25% of all ED encounters. Emergency medicine quality improvement efforts and recent Geriatric ED Accreditation prioritizes the care of this complex population and provide a framework for Geriatric ED care. Recommendations include the incorporation of Geriatric ED liaisons or case managers to perform geriatric screens and care coordination, however staffing limitations may limit real-world implementation of this care.
Objective : We aim to describe the incorporation of a novel workforce into geriatric emergency care at a large, urban Veterans Affairs Medical Center (VAMC). Former military medics and corpsmen, employed as Intermediate Care Technicians (ICTs), have been trained in geriatric screens, VA and community resource allocation, and care transitions since 2016. We will describe the training curriculum for these unlicensed medical personnel and provide a framework for its implementation with other non-traditional geriatric staff.
Methods : Through collaboration with the Cleveland Geriatric Research Education and Clinical Center (GRECC), VHA Innovators Network, multidisciplinary content experts, and Cleveland VAMC Medical Media, a multimodal training curriculum was developed for non-traditional geriatric ED personnel based on the GERI-VET program. Case-based didactics, educational webinars, and simulation based training were developed for the screening and care of geriatric syndromes. Decision support tools were created in the electronic health record for positive geriatric syndromes.
Outcomes : Locally, 9 ICTs and 2 licensed practical nurses received training and cared for 508 patients with GERI-VET consults between 12/1/16-12/19/18. Competencies for each topic were developed to ensure educational objectives have been met. Case-based videos and job aids for each geriatric screen were developed and made available on the GERI-VET website. Given interest from non-local EDs, a condensed Train-the-Trainer bootcamp was held in July 2018, with 30 multidisciplinary participants from 5 VAMC sites in attendance.