Geriatric Emergency Management Network (GEM)

Provincial Initiative

Who is GEM for?

Geriatric Emergency Management (GEM) Nurses provide specialized frailty focused nursing services in Emergency Departments (ED) to older adults presenting to the ED. Their role in conducting targeted geriatric assessment and identifying older adult specific interventions is important as older adults may be under-triaged and under-treated in acute care settings. Evidence has demonstrated that health professionals with specific preparation in conditions affecting older adults (e.g. geriatric training) can aid in timely recognition and treatment, and impact admission and length of stay.

GEM nurses also contribute to capacity building among others working in the ED, as well as community partners, by sharing knowledge and skills, acting as resource persons, and collaborating with others in the care of older adults. GEM nurses spend time each week teaching, mentoring and coaching, and supporting the implementation of Senior Friendly Care and geriatric protocols in the ED, across acute care organizations and in other environments.

Why do we need GEM?

Older adults represent as many as 30% of the patients seen in Emergency Departments, more than any other age group. Illness complexity, hospital admission rates, lengths of stay and risk of functional decline are also highest for older adults. Indeed, emergency department visits are often sentinel events for older adults, threatening loss of independence, health and wellbeing. By providing specialized frailty friendly services in Emergency Departments, decline and loss of independence can often be prevented or postponed and repeat ED visits can be minimized.

How do GEM nurses differ from other ED nurses?

Emergency departments are developing specialized services to meet unique population needs such trauma, mental health, sexual assault and domestic violence. The needs of older adults are similarly unique and the presence of a specialized GEM nurse can help EDs manage the care of older adults living with frailty more effectively. GEM nurses bring with them knowledge of aging, understanding of the common geriatric syndromes and atypical presentation patterns, as well as intervention and prevention strategies that will help older adults maintain their level of independence and wellbeing. As a specialized role, GEM nurses focus on clinical consultation with patients and ED staff, education of patients/families and ED staff and in capacity building initiatives within their community and through provincial liaison.

How are referrals made to GEM nurses?

The use of a routine standardized risk screen is encouraged for all older adults who come to emergency departments. Scores on the risk screen completed during primary assessment will indicate the need for a referral to the GEM nurse. Paramedic and ED staff can also ask GEM nurses to see older adults when they have an intuition or “gut feeling” that the GEM nurse could help even if a risk screen score is not high. Older adults and their family members might also ask for the GEM nurse to become involved.

Steps in emergency department patient flow and triggers of GEM referral

What is the GEM Network?

The Geriatric Emergency Management nursing network links nurses providing specialized frailty focused nursing services in many of the province’s emergency departments. It comprises 130 nurses in 60 emergency departments across Ontario lending their expertise to achieve better health outcomes for older adults living with or at risk of frailty.

Key Reference

Ryan, D., Flynn, DS., & Wilding, L. (2018). AN OVERVIEW OF GERIATRIC EMERGENCY MANAGEMENT NURSING PRACTICES IN ONTARIO. Perspectives-Gerontological Nurses Association, 39(4), 6-13.

Who can I call to find out more about the GEM initiative in Ontario?

Please contact: info@rgpo.ca