Are you aware that the Institute of Medicine estimates that health care systems require, on average, 17 years for 14 percent of high-quality, practice-changing research to reach the bedside? Multiple leaks in the “knowledge translation pipeline” contribute to this knowledge decay at the patient–provider interface, led by awareness and acceptance. Implementation scientists understand that traditional educational efforts and published manuscripts alone are insufficient to drive practice change. Alternative outside-the-box thinking is needed.
The ACEP Geriatric Section, in conjunction with the American Geriatrics Society and the Society for Academic Emergency Medicine Academy for Geriatric Emergency Medicine, and with funding from the John A. Hartford Foundation, recently developed the Geriatric Emergency Department (GED) Boot Camp to assist hospital systems interested in “geriatricizing” their community EDs. The core components of this boot camp are based upon the ACEP Board of Director–approved GED Guidelines.
First, contemporary geriatric care mandates an interdisciplinary approach, especially in the ED. By necessity, most off-site medical conferences like the ACEP Scientific Assembly are attended by only a fraction of each institution’s health care team, because somebody has to staff the ED. In addition, cost constraints increasingly affect attendees’ abilities to travel to conferences. More importantly, these conferences are focused toward one specialty and one set of health care providers: nurses or physician extenders or physicians. In contrast, the two-day GED Boot Camp brings the curriculum and expertise to the individual hospital system so that local nurses, technicians, physical therapists, case managers, hospital administrators, insurers, community organizations, patient advocacy groups, and physicians from multiple specialties have the opportunity to attend and participate without incurring travel expenses.
Second, the needs of each hospital to “geriatricize” care efficiently and effectively must be identified by their leadership. A one-size-fits-all educational product is unlikely to be of uniform utility for every hospital. Therefore, the GED Boot Camp includes a pre-event needs assessment survey. Each GED Boot Camp site self-identifies their programmatic priorities, curricular needs, and short-term objectives based upon this survey. Each GED Boot Camp program is therefore customized and developed to meet the needs and objectives of the participating hospital site.
Third, because traditional didactic education is usually insufficient to change practice or advance the standard of care, each site identifies at least one quality improvement (QI) project to adapt the GED Guidelines for their institution. The specific QI project for each site requires engagement of local opinion leaders and hospital leadership, access to meaningful before and after patient- or system-level metrics, and a process to measure adaptability of individual GED Guidelines. The QI projects identified by each site are monitored by GED Boot Camp faculty for one-year after the event to access outcomes.