Key documentation for evaluating your implementation

Quantitative analysis

Your hospital Emergency Department Information System (EDIS) will collect information on all presentations to the ED. The following is a list of data items for a minimum data set required to perform a baseline analysis of presentations to the ED for persons aged 70 years and over and Aboriginal and Torres Strait Islander peoples aged 55 years and over.

A list of data items for a minimum data set

Description	Data item for collection	Evaluation
Time of arrival to the ED/hospital	Arrival Date	Arrival Date minus Departure Actual At = length of stay in the ED
Time of departure from the ED	Departure Actual At
Length of stay in the ED to ready to leave ED - to account for access block to the hospital	TimeDiff Arrival Depart. Ready	TimeDiff Arrival Depart. Ready minus Departure Actual At = access block
Diagnosis code for presentation to the ED	Diagnosis ICD Code Primary	Provide frequency of type of presentation to the ED NB: ICD 10 code can be converted into 25 systems for easier analysis of conditions
Date of death – this date is usually only present for an in-hospital death	Died At	Can be used to provide mortality data in the ED/inpatient setting
How the person arrived to the ED	Mode of Arrival Code	Provide frequency of method of transport to the ED
Triage number using Australasian Triage Scale (1-5)	Triage Priority	Provide frequency of triage priority in the ED
Assigned hospital Medical Record Number	MRN Medical Record Number	Unique identifier for linking of information with inpatient hospital data
Age at time of presentation	Present age in years	To identify all presentations in the geriatric age group (>=70)
Gender	Present gender	To determine percentages of Males and Females presenting in this cohort
Person identifies as Aboriginal, Torres Strait Islander or both Aboriginal and Torres Strait Islander	Indigenous status	To determine percentage of Aboriginal, Torres Strait Islander or both Aboriginal and Torres Strait Islander presenting in this cohort
Postcode	Present postcode	To determine main geographical areas where presentations are from i.e. seasonal flux; high presenting RACF
Optional created fields in EDIS
GEDI interactions	GEDI fields	GEDI referred – referred to GEDI GEDI attended – seen by GEDI

Data from the hospital admission management database (HBCIS) Hospital Based Corporate Information System should contain the following information for older people admitted to hospital via the ED. Linking of the information via the Unit Record Number or admission episode will provide further information on hospital admissions. Contact your Data manager to determine how this can be achieved.

Information that the Hospital Based Corporate Information System should contain

Admission to a ward within the ED
Time of admission to a ward WITHIN the ED i.e. Short Stay Unit (SSU) (not hospital inpatient)	Admitted at	Date time of admission minus Departure Actual At = length of stay in the ED in addition to initial ED stay
Time discharged from ward within the ED i.e. SSU	Departure actual at
Discharge home or admission to hospital as inpatient	Departure destination	To determine how many people went home or were admitted
If transferred, name of hospital transferred to	Transfer destination Hospital Code
In hospital mortality	Died at	Died as inpatient
Admission to hospital as inpatient
Time of admission to hospital as inpatient	In-patient admit date/ time
Time of discharge from hospital to place of residence	Inpatient discharge date/ time
Discharging ward/unit	Discharge ward
Length of stay as inpatient (separate to stay in the ED)	fractional length of stay
In hospital mortality	Died at	Died as inpatient

• Numbers of persons >=65 years of age and over presenting to the ED; discharged from the ED, transferred, admitted in hospital, died, departure status
• Average age of people >=65 years of age who present to the ED
• Most common presentation types (ICD-10 code or category)
• Percentages of people presenting in each triage category (1-5)
• Average length of stay in the ED
• Average length of stay if admitted to hospital as inpatient (calculated in bed days)

Representations can be calculated with more advanced statistical methods.

Once you have baseline data, you can then track any changes to these data items over identified time periods of implementation of your GEDI service. The GEDI team may also wish to collect other data such as the items listed here. View example GEDI data collection sheet.

Additional data that may be collected

Additional data to be collected / used if available
Identify if person is from a residential aged care facility	RACF Yes/No	To determine frequency of presentations from RACFs to compare with aged people from community
Name of facility (if available)	RACF NAME	To identify facilities with highest numbers of transfers
Screening tool score collected by GEDI nurse (i.e. InterRAI, TRST, ISAR)	CFS score	These scores are used to determine if GEDI team involvement is required

Health Economic cost effectiveness analysis

Information on the cost and cost savings of your GEDI service will be beneficial in asserting the value of the service with hospital administrators. This can then be used to leverage funding for increasing GEDI positions and hours of coverage in the ED.

Your hospital financial databases should contain data on the total cost of the presentation to ED and admission to hospital. Together these costs provide information on the cost of a presentation and subsequent admission which can be used to provide information on any reductions since your GEDI service is in place.

Data to collect	Data item
Total cost of ED presentation	Total ED cost
Total cost as inpatient alone	Total inpatient cost

From this data you can calculate the:

• Average cost of presentation to the ED
• Average cost of admission to hospital

Cost saved can be demonstrated by a reduction in hospital admissions in this cohort. For example; these results from the GEDI research evaluation show:

Item	Pre GEDI time period	Post GEDI time period	Savings
Number of admitted bed days	649	480	169 bed days saved
Average Inpatient Cost	$4897.66	$7,320.00
Inpatient cost TOTAL	$1,430,115,61	$911,340.08	$518,775.53

Additionally, opportunity costs of empty beds that can be utilised for:

• Day surgical patients
• Elective patients

This will potentially have a positive impact on benchmarked targets such as the National Elective Surgical Targets (NEST).

While the presentation of graphs, figures and cost savings can be quickly understood by management, how the service works in practice is of far more concern to the staff who work in the ED and the older people and their families experiencing the GEDI service. For this reason, evaluation of the structures and processes in place to enable the GEDI service to operate is critical in assisting with acceptance and change management.

To do this as a quality improvement activity, interviews with key staff, management and users of the service are recommended. Potential interviewees include:

• GEDI nurses in the ED
• Other nurses working in the ED (both clinical and managerial)
• Medical and Allied Health staff in the ED
• Management who the GEDI team report to
• Patients who have been seen by GEDI nurses and their carers or family members

Suggested areas of inquiry can be seen below, adapted from Irvine, Sidani & Hall (1998) Nursing Role Effectiveness Model:

From these areas of inquiry, interview or survey questions can follow these pathways:

Structure pathways

Service (GEDI) structure
Setting	General information physical area of the services provided, clients seen
Staffing	Staffing requirements needed to operate GEDI
Organisational structure
Access to resources	What resources are available? Ways of overcoming lack of access to resources – Funding for staffing? Availability of resources so that the service can function i.e. ability to contact GEDI, community services, family
Physical structures	Physical components needed for GEDI to operate – space, tools used
Road map of social structure	Informants’ views on key personnel – acceptance, ability
Barriers	Barriers to setting up – continuous funding GEDI, time for service provision, sustainability
Barrier solutions	Solutions to identified barriers

Process pathways

Interventions
Regular event chronology	Regular practices; good processes of care
Irregular event chronology	Irregular practices; poor process of care
Referral
Referral practice before GEDI	Practice before GEDI
Referral practice after GEDI	Practice after GEDI and after hours
Problem-solving	What healthcare providers do when issue arises i.e. what happens after hours; GEDI unavailable
Role
Key features of GEDI team roles	Activities undertaken by GEDI team
Changes in working practices	Perception of how practice has changed
Communication
Inter personnel communication	Methods of communication between team and other healthcare professionals
Patient involvement	Methods of communicating to patient
Patient satisfaction: Information	Information: about condition and treatment
Improvement
Room for improvement – GEDI team roles	Recommendations for improving GEDI team roles
Programme improvement recommendations	Patient’s programme improvement recommendations

Complaints and compliments

Set up a complaints and compliments folder for interested parties including patients to improve the service and use positive quotes for service evaluation. In addition, it may be useful to collect data on interesting cases to present at regular GEDI team and hospital meetings as examples of hospital deficiencies and successful GEDI team patient interactions.

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