How a geriatrician-led emergency department model works in practice: a realist evaluation.
Background Embedding geriatric medical expertise in the emergency department (ED) is proposed to improve care for older people, yet the underlying mechanisms and context causing impact to remain poorly understood. Objective To develop programme theories explaining how, why, and under what conditions...
| Publicado en: | Age & Ageing Vol. 55; no. 2; pp. 1 - 11 |
|---|---|
| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Feb2026
|
| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=192513164&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 192513164 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Feb2026 vid: 55 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 192513164 10.1093/ageing/afag036 ppf: 1 ppct: 10 formats: tig: atl: How a geriatrician-led emergency department model works in practice: a realist evaluation. aug: au: Yap, Celene Y L Ho, Lannie Braitberg, George Gerdtz, Marie Murray, Michael Yates, Paul Lee, Kathryn Wong, Lee Yung Amadoru, Sanka Haywood, Cilla affil: The University of Melbourne - Department of Critical Care, Parkville, 3010, Victoria, AustraliaNational Ageing Research Institute Parkville, 3050, Victoria, AustraliaAustin Health - Emergency Department, Heidelberg, 3084, Victoria, Australia Austin Health - Department of Geriatric Medicine, Heidelberg, 3084, Victoria, Australia The University of Melbourne - Department of Critical Care, Parkville, 3010, Victoria, AustraliaAustin Health - Emergency Department, Heidelberg, 3084, Victoria, Australia La Trobe University – Nursing, Bundoora, 3086, Victoria, Australia Austin Health - Department of Geriatric Medicine, Continuing Care Division, Heidelberg,3084, Victoria, Australia Austin Health - Medical and Cognitive Research Unit, Department of Geriatric Medicine, Continuing Care Division, Heidelberg, 3084, Victoria, AustraliaThe University of Melbourne - Department of Medicine, Parkville, 3010, Victoria, Australia Austin Health - Emergency Department, Heidelberg, 3084, Victoria, Australia Austin Health - Department of Geriatric Medicine, Heidelberg, 3084, Victoria, AustraliaThe University of Melbourne - Department of Medicine, Parkville, 3010, Victoria, AustraliaBendigo Health, Bendigo, 3550, Victoria, Australia The University of Melbourne - Department of Critical Care, Parkville, 3010, Victoria, AustraliaAustin Health - Department of Geriatric Medicine, Continuing Care Division, Heidelberg,3084, Victoria, Australia su: Australia Theory-practice relationship Self-evaluation Professional autonomy Human services programs Medical quality control Diffusion of innovations Focus groups Qualitative research Interprofessional relations Evaluation of human services programs Interviewing Hospital admission & discharge Emergency medical services Sound recordings Professional practice Medical consultants Hospital emergency services Descriptive statistics Decision making in clinical medicine Tertiary care Continuum of care Geriatric assessment Research methodology Data analysis software Length of stay in hospitals sug: subj: Theory-practice relationship Self-evaluation Professional autonomy Human services programs Medical quality control Diffusion of innovations Focus groups Qualitative research Interprofessional relations Evaluation of human services programs Interviewing Hospital admission & discharge Emergency medical services Sound recordings Australia Emergency and Other Relief Services Municipal police services Administrative Management and General Management Consulting Services Sound recording merchant wholesalers Record Production Integrated Record Production/Distribution Specialty (except Psychiatric and Substance Abuse) Hospitals Professional practice Medical consultants Hospital emergency services Descriptive statistics Decision making in clinical medicine Tertiary care Continuum of care Geriatric assessment Research methodology Data analysis software Length of stay in hospitals keyword: boundary spanning care transitions copyrightHolder:British Geriatrics Society copyrightYear:2026 emergency department emergency service geriatric care geriatricians hospital hospital admission https://dx.doi.org/10.1093/ageing/afag036 inLanguage:en older adult older people patient disposition publisher:Oxford University Press qualitative research realist evaluation sameAs:https://pubmed.ncbi.nlm.nih.gov/41719427/ transition of care boundary spanning care transitions copyrightHolder:British Geriatrics Society copyrightYear:2026 emergency department emergency service geriatric care geriatricians hospital hospital admission https://dx.doi.org/10.1093/ageing/afag036 inLanguage:en older adult older people patient disposition publisher:Oxford University Press qualitative research realist evaluation sameAs:https://pubmed.ncbi.nlm.nih.gov/41719427/ transition of care ab: Background Embedding geriatric medical expertise in the emergency department (ED) is proposed to improve care for older people, yet the underlying mechanisms and context causing impact to remain poorly understood. Objective To develop programme theories explaining how, why, and under what conditions a geriatrician-led innovation model improves care for older people presenting to the ED. Methods We conducted a realist evaluation of a geriatrician-led innovation in the ED. Data were generated through non-participant observation, document review, interviews and focus groups with geriatricians, ED clinicians, surgical and general medicine teams. Analysis was abductive and retroductive, iteratively configuring data into context–mechanism–outcome configurations to produce programme theories. Results Sixteen interviews and five focus groups were conducted. We developed programme theories suggesting that embedding a geriatrician in the ED triggered timely disposition planning, strengthened care transitions, and fostered informal capability building. These outcomes arose through mechanisms of trust-building and boundary spanning, activated in contexts where specialist authority was recognised, trust with ED teams was established, and staffing capacity was sufficient. Limited after-hours coverage and competing ED priorities constrained these mechanisms, resulting in the deferral of some treatment and disposition decisions to the geriatrician, reducing intended efficiencies of timely and coordinated care. Conclusions This study advances understanding of how a geriatrician-led innovation model in an ED improve care delivery for older people by identifying the mechanisms and contextual conditions that shape their impact. The theories developed offer a foundation for ongoing theory building, requiring continued testing and refinement across diverse ED settings. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
|---|