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Northwestern nurse program helps improve care for elderly in ED

Monday May 5, 2014
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Dwayne Dobschuetz, RN
For more than two decades, Dwayne Dobschuetz, RN, MSN, has dedicated his career to tending to the never-ending stream of patients coming through the doors of the EDs at the hospitals at which he has served.

But for a little more than a year, Dobschuetz said, that passion for the ED has been transferred to a slightly different professional endeavor thanks to the creation of what he and others at Northwestern Memorial Hospital in Chicago refer to as GEDI.
Pronounced “Jedi,” GEDI stands for the Geriatric Emergency Department Initiative, a three-year long program run by Northwestern to improve the care of elderly patients in the ED.

“When the opportunity was presented to me, I just felt so strongly that I needed to be a part of this,” Dobschuetz said. “I love being an ED nurse, I do. But when an opportunity comes up to be a part of something this significant, I couldn’t resist.”

The program was launched a year ago. Amer Aldeen, MD, associate medical director at Northwestern, said he and others overseeing the program believed a key to the program’s success was recruiting the right nurses.

“We needed very highly experienced, well-regarded nurses,” Aldeen said. “And the first four we brought through the training program collectively had 99 years of clinical experience.”

That level of experience, Aldeen said, was essential because of Northwestern’s ED space constraints, which would not allow the hospital to dedicate space specifically for geriatric emergency treatment. For the new care program to succeed, the ED would need skilled, seasoned, specially trained GEDI nurses.


Alicia Salgado, RN
Officially designated as geriatric nurse liaisons, Dobschuetz and fellow GEDI nurses, including Alicia Salgado, RN, BSN, said the amount of time they can dedicate to care is the central difference between the care they might provide to an ED patient and that is provided to a GEDI patient.

“There’s a big demand for beds in the ED,” Salgado said. “So time constraints are a big thing. With this program, we have the time to really evaluate our patients, know our patients, talk to their family, and see what their needs really are.”

Dobschuetz said the experience is, in many ways, similar to the care he provided to his mother during the final 14 years of her life and during her struggle with Alzheimer’s disease.

“Home is the best place for them in most cases,” Dobschuetz said. “But there are patients we talk with and we learn pretty fast that they might be going back to a place where they have to climb a number of steps to get to their door. If they can’t walk here, they’re probably going to fall there and then they’ll be right back here.”

The GEDI nurses have the ability to stay with the patients, earn their trust and help them navigate the healthcare system, arranging for various services and tools to make their lives easier.

Finally, the nurses will follow up with the patients in later days to assure they are following their doctors’ instructions and have what they need to assure no return engagements at the ED.

Since its inception, the GEDI program has reduced hospital admissions sharply among elderly patients. Among those ED patients treated under the GEDI program, hospital admission rates dropped from 55% in 2012 to 35% since April 2013.

As the program prepares to enters its third year of funding, Aldeen said, the hospital hopes to “expand our reach” to see how the program can do with a larger number of patients, in the hope that “the hospital will see the net benefit.”

From there, he hopes the program can become a model for other hospitals which, like Northwestern, cannot dedicate space or large resources to similar initiatives.

For now, though, Salgado and Dobschuetz said they would like to be allowed to continue to work on the initiative they have come to enjoy.

“I was really skeptical when I was first recruited,” Salgado said. “But I’m enjoying this a lot. It’s like putting a puzzle together every day with every patient, to make sure my patients go home and don’t need to come back to the ED.”


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