Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
Geriatric Emergency Medicine Unit (GEMU) provides older adults with specialised, supportive emergency care in a dedicated Emergency Department (ED) zone, improving safety, access, and patient flow while enhancing the overall care experience.
Dates: January 2025 - ongoing
Implementation sites: Metro South Hospital and Health Service
Aim
To redesign emergency care for older adults to ensure timely, calm, and dignified treatment while improving patient flow and reducing preventable harm.
Outcomes
March to May 2025 evaluation period reported for emergency patient age 70 years and over:
- 61.9% faster Emergency Department bed allocation (105 → 40 minutes)
- 29.6% faster clinician review (142 → 100 minutes)
- 84% reduction in patients remaining in Emergency Department longer than 24 hours
- Five-fold reduction in 72-hour re-presentations for patients aged 70 and over
- Strongly positive patient and carer feedback regarding comfort, experience and dignity of care
Background
Australia's ageing population is growing rapidly, and older adults frequently present to emergency departments (EDs) with complex medical needs including multimorbidity, frailty, polypharmacy, and social vulnerability. These factors contribute to prolonged ED stays and increased risk of hospital-acquired complications such as delirium, falls, and mortality.
In 2024, 11,465 patients aged over 70 presented to Logan ED, with 51.6% requiring admission. Although they comprised only 14.4% of presentations, they accounted for 47% of ED stays exceeding 24 hours. Extended stays increase the risk of delirium, functional decline, and mortality. Traditional ED environments are not designed for frail older adults, and direct patient feedback highlighted stress, confusion and discomfort during prolonged ED stays. Systemic challenges, including unconscious age bias and under-triage, further delay care and increase the risk of preventable harm. These findings prompted the development of a dedicated, age-appropriate model of care.
Methods
Launched in February 2025, GEMU provides dedicated six-bed space for patients aged >70 (>55 for First Nations patients), supported by geriatric-trained medical, nursing and allied health staff.
Model of Care:
- A designated zone within the ED, redesigned for patients aged 70+ and first nation 55+
- The unit features a low-stimulus, age-friendly environment with pressure-relieving mattresses, fall-prevention beds, orientation clocks, and cognitive aids.
- Integrated, multidisciplinary team including ED clinicians, geriatricians, nurses, pharmacist and allied health
- Focus on both clinical and non-clinical needs: comfort, mobility, availability of food and drink and Skywalker volunteer support
- Streamlined assessment, early intervention, and discharge planning tailored to older patients
Discussion
Implementing the Geriatric Emergency Medicine Unit (GEMU) required both physical redesign and a significant shift in how emergency teams understand the care needs of older adults. Repurposing space within an already pressured ED, without new capital or additional staffing, presented substantial challenges. Success depended on strong interdisciplinary collaboration, deliberate workflow redesign, and the willingness of staff to trial new processes in an overstretched environment.
A major lesson was the need to change perceptions about the complexity of older adults' presentations. Unlike typical acute ED presentations, older patients frequently present with multimorbidity, cognitive impairment, frailty, behavioural symptoms, and substantial psychosocial needs. These factors often appear to "slow flow" in traditional ED models. Through regular education and awareness, comprehensive geriatric assessment, early allied health input, and support in managing dementia related behaviours, staff gained confidence and recognised that structured, holistic care ultimately enhances safety and patient flow rather than impeding it
Early GEMU data from March'May 2025 demonstrate that thoughtful redesign and the right expertise at the front door, we can transform patient flow and create better experiences for some of our most vulnerable patients . Consumer feedback has been overwhelmingly positive, with older people and their carers reporting calmer environments, clearer communication, and more respectful care. These experiential improvements align with measurable operational gains, including shorter waiting times, early bed allocation, and reduced representations.
Despite these gains, whole of hospital access pressures continue to limit improvements in ED Length of Stay, highlighting dependencies outside GEMU's direct control. Working with limited resources emphasised the need for sustained organisational support as the model matures.
Strengths of the project include its low cost, high value design, strong patient centred focus, and adaptability across a range of ED settings. Weaknesses include reliance on repurposed staffing and the constraints of a small physical footprint. Opportunities exist to further expand geriatric expertise, strengthen care and discharge pathways, and extend allied health availability beyond the business hours to meet growing demand.
Given Queensland's ageing population, the GEMU model is well positioned to succeed in other EDs, particularly those with high volumes of older adults. Next steps include refining workflows, strengthening partnerships with community services, and ongoing evaluation to guide potential statewide scalability.
References
1. PHN Brisbane South. Older Persons Health and Wellness Desktop Summary. Brisbane South PHN; Oct 2023.
2. Australian Bureau of Statistics. Population Projections, Australia, 2017'2066. ABS; 2018.
3. Logan Hospital Emergency Department. ED Activity Data 2024 and GEMU Evaluation Data March'May 2025. Metro South Health; 2025.
4. Bo M, Bonetto M, Bottignole G, et al. Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients. J Am Geriatr Soc. 2016;64(5):1114'1119.
5. Natalie C, Kelly M, Keegan M, et al. Emergency Department Length of Stay Is Associated With Delirium in Older Adults. West J Emerg Med. 2023;24(3):532'537.
6. van Loveren K, Singla A, Sinvani L, et al. Increased Emergency Department Hallway Length of Stay Is Associated With Development of Delirium. West J Emerg Med. 2021;22(3):726'735.
7. Australasian College for Emergency Medicine. Policy on the Care of Older Persons in the Emergency Department (P51). Version 6.0; 2022.
8. ACEP. Geriatric Emergency Department Guidelines. American College of Emergency Physicians; 2013.
9. ACEP. Geriatric Emergency Department Accreditation (GEDA) Criteria. American College of Emergency Physicians; Current Version.
10. Kahn JH, Magauran BG, Olshaker JS, Shankar KN. Current Trends in Geriatric Emergency Medicine. Emerg Med Clin North Am. 2016;34(3):435'452.
11. Ellis G, Gardner M, Tsiachristas A, et al. Comprehensive Geriatric Assessment for Older Adults Admitted to Hospital. BMJ. 2017;354:i341.
12. Carpenter CR, Mooijaart SP. Frailty Screening in the Emergency Department: A Systematic Review. Acad Emerg Med. 2020;27(8):671'685.
13. Sinha SK, Kennedy C. Geriatric Emergency Departments: The Future of Emergency Care for Older Adults. Can Geriatr J. 2012;15(3):59'62.
14. Hwang U, Dresden SM, Rosenberg M, et al. Geriatric Emergency Department Innovations: Results From the Geriatric ED Collaborative. J Am Geriatr Soc. 2023;71(1):45'55.
15. Vandenberg AE, McDonald SR, Carpenter CR. Delirium Prevention in the Emergency Department: Evidence and Strategies. Clin Geriatr Med. 2023;39(2):159'175.
16. Queensland Health. Queensland Older Persons Health Strategy 2023'2033.
Key contact
Dr Golam Sarwar
Emergency Staff Specialist
Logan Hospital