Please cite this article in press as: Marsden EJ, et al. A structure and process evaluation of the Geriatric Emergency Department Intervention model. Australasian Emergency Care (2020), https://doi.org/10.1016/j.auec.2020.05.006 ARTICLE IN PRESS G Model AUEC-473; No. of Pages 6 Australasian Emergency Care xxx (2020) xxx–xxx Contents lists available at ScienceDirect Australasian Emergency Care jo u r nal home page: www.elsevier.com/locate/auec Research paper A structure and process evaluation of the Geriatric Emergency Department Intervention model Elizabeth J. Marsden a,b,* , Andrea Taylor a,b , Marianne Wallis b,d , Alison Craswell b , Marc Broadbent b , Colleen Johnston-Devin b,e , Julia Crilly c,d a Nambour Emergency Department, Sunshine Coast and Hospital Health Service, Hospital Rd, Nambour, QLD 4560, Australia b School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556, Australia c Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD 4215, Australia d Menzies Health Institute Queensland, Griffith University, Parklands Drive, Parkwood, QLD 4215, Australia e School of Nursing, Midwifery and Social Sciences, CQUniversity, 90 Goodchap St, Noosaville 4566, Australia a r t i c l e i n f o Article history: Received 4 March 2020 Received in revised form 23 April 2020 Accepted 25 May 2020 Keywords: Qualitative research Models Nursing Long term care Advanced practice nursing Emergency medical services a b s t r a c t Background: The positive effect of the Geriatric Emergency Department Intervention (GEDI) model, on the outcomes of frail older adults, is established. This study aimed to describe and evaluate the structures and processes required for the effective delivery of the GEDI model to assist in its potential translation into emergency departments in Australia and overseas. Methods: This was a descriptive qualitative study. Twenty-four semi-structured interviews were con- ducted with emergency department staff and GEDI doctors and nurses from a regional hospital in Queensland, Australia. An a priori framework guided interview questions and analysis. Results: Structures required for successful model deployment included having an emergency department physician champion and nurses with gerontology experience, adequate funding, and geriatric specific resources. Processes identified as fundamental to the GEDI model included having a targeted approach to assessment, a patient-centred approach to care, and staff with inter-facility, intra-facility and inter- personal communication skills. Conclusions: The GEDI model addresses the specific care needs of our aging population. For optimal perfor- mance of the model, key structures and processes require identification and acknowledgement. Research involving qualitative methodology is vital for successful translation and integration of emergency depart- ment models of care. Crown Copyright © 2020 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved. Introduction The substandard provision of healthcare to Australia’s older population in residential aged care facilities (RACFs) has recently been highlighted by a Royal Commission [1]. This may, in part, be reflected in the high rate of transfer of residential aged care facility (RACF) residents to emergency department (ED) for the management of non-life threatening conditions [2]. The subopti- mal environment EDs provide for the care of the frail older adult is a recognised issue [3], reflected in a systematic review on the views and expectations of frail older adults, and their carers, in relation to their ED care experiences [4]. Key concerns included: * Corresponding author at: Sunshine Coast University Hospital, 6 Doherty St, Birtinya, QLD 4576, Australia. E-mail address: ejm032@student.usc.edu.au (E.J. Marsden). lack of information and education surrounding care and ED pro- cesses, prolonged ED wait times, suboptimal physical environment and patients left feeling abandoned and isolated [4]. Recent mod- els embedded in the ED have sought to address these concerns and improve the older adult’s journey through the ED. These models include, but are not limited to: nurse-led discharge planning [5]; volunteers [6]; telephone triage and care coordination programs and comprehensive geriatric assessment units [7]. A model that utilises a combination of some of these approaches, is the Geriatric Emergency Department Intervention (GEDI) model. GEDI is a nurse-led ED based intervention targeting all older adults aged over 70 years; prioritising those from RACFs. The GEDI advanced practice nurses work as subspecialty consultants within a multidisciplinary team assisting the ED physicians and primary ED nursing staff in the care of the frail older person. This model success- fully decreases ED length of stay (LoS) and cost whilst increasing https://doi.org/10.1016/j.auec.2020.05.006 2588-994X/Crown Copyright © 2020 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved.