A geriatric consultation team in the emergency department.

BACKGROUND: The proportion and absolute number of older patients presenting to emergency departments (EDs) are increasing. Older ED patients tend to have multiple medical and psychosocial problems that make their care in the ED problematic. Despite this, there have been no previous descriptions of geriatric ED consultative services.
SETTING: The Sir Mortimer B. Davis Jewish General Hospital is a 628-bed tertiary care McGill University teaching hospital. It serves a population of about 160,000, of which 23% are aged 65 and older. In response to the special needs of this group, the Division of Geriatric Medicine at the Jewish General Hospital has developed, among its clinical and teaching services, an ED consultation team. PROGRAM DESCRIPTION: The consultation team is composed of a geriatrician, a full-time nurse clinician, and part-time physical and occupational therapists. Consultations are received from referring, primarily Ed physicians and encompass all aspects of medical and psychosocial issues. Geriatric assessment is geared toward decision making for rapid disposition: discharge home or admission to acute geriatrics ward or other services. Thus, the service functions as a gatekeeper for admission to the acute geriatrics ward, as well as coordinating geriatric follow-up both in-hospital (for patients admitted to other services) and in the community (for patients discharged home), via the outpatient geriatric clinic, home visits, or linkage to other community resources.