Embedding Care in the ED: Liz Goldberg and Lauren Southerland

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GeriPal - A Geriatrics and Palliative Medicine Podcast 47 min 3 speakers 6 chapters transcribed 10 hours ago

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What motivated the hosts to explore embedding geriatric care in the emergency department?

Eric Widera 0:00

This podcast is not see me eligible. If people do want to learn more about see me eligible podcasts, Alex, what do they do?

Alex Smith 0:07

They can go to JerryPal dot org backslash CME.

Eric Widera 0:13

And on to the show. Welcome to the JerryPal podcast. This is Eric Wadera. This is Alex Smith. And Alex, we got a great topic today. I can't believe we haven't we we talked about palliative care in the emergency room. We haven't really talked about integrating geriatrics or integrating specific programs in the emergency department for vulnerable older adults, but today we do. Alex, who do we have with us to talk about this subject?

Alex Smith 0:39

Well, I talked to Liz at the Beeson meeting in DC a few months ago. Liz who was like, I haven't been on the Jerry Powell podcast and I was like, You're right. That is shocking and you absolutely should be on the Jerry Powell podcast. So I'm so glad to welcome Liz Goldberg, who is emergency medicine doctor and researcher and associate vice chair for research at the University of Colorado. and past president of the Academy for Geriatric Emergency Medicine. Liz, welcome to the JerryPal podcast.

Liz Goldberg 1:12

Thanks so much for having me. Excited to be here.

Alex Smith 1:14

And we are delighted to welcome Lauren Sutherland, who is also an emergency medicine doctor and researcher and director for clinical research at the Ohio State University. Lauren, welcome to the Jerry Powell podcast.

Lauren Southerland 1:28

Glad to be here with all of you.

Eric Widera 1:31

So we got a lot to talk about, about integrating programs to the emergency room for older adults. But before we go into that topic, Lauren, do you have the song request for Alex? Actually

Liz Goldberg 1:40

I didn't

Eric Widera 1:41

Oh, Liz has a song of this. I should have wrote that down. What's the song?

Liz Goldberg 1:46

It is Gravity by John Mayer and it's because I love everything false prevention and gravity is just yeah, it's wicked.

Alex Smith 1:54

Yeah. That's good.

Eric Widera 1:55

Alex, you just did Gravity and Wicked, right?

Alex Smith 1:58

What's that? Oh well last week we did Defying Gravity. So we're kind of on a gravity kick here. We are. All right, here's a little bit.

Unknown 2:21

Gravity Working against me. And gravity. Wants to bring me down. Oh I'll never know. What makes this mad? With all the love That his heart can stand. And dream of wave. To throw it off. Away. Gravity. Is working against me. And gravity. Who wants to bring me down? Oh and twice as much. Ain't twice as good and can't sustain like one half could it's wanting more that's gonna send me to my need.

Alex Smith 3:49

I gotta stop or I'll just go on this. I love that song.

Eric Widera 3:53

Great choice, Liz. All right, Liz, I'm gonna start off with you. What got you interested in older adults in the merch room, integrating geriatric principles? Like, where did this come from?

Liz Goldberg 4:08

Yeah, happy to tell my origin story.

Eric Widera 4:11

Yeah.

Liz Goldberg 4:11

Uh I worked at a busy level one trauma center in residency and we did these 24 hour shifts that were pretty grueling on the trauma service where we saw all the ED patients that came in for serious injuries. And one thing that irked me as a as a resident on that service was we would see so many patients come in with falls and it felt like there was so much variation in care. Sometimes we would admit them for maybe this was syncope. Sometimes they were discharged. We almost never figured out what their etiology was for their fall. And then we would see them back. But next time I was on call, it was like a 72-hour call situation or 24 hours. And I'd be back on 72 hours later.

How did Liz Goldberg’s experience with fall patients lead to the creation of GAPcare?

Liz Goldberg 4:53

And I was like, we need to do something about this. So I walked up to our case managers and said, you know, what do you think we need to do for these false patients? And they had just done this audit and they had learned that they really needed PT services in the ED. And that would be so helpful because we would be able to identify functional impairment and lower extremity strength issues. And so I dreamed up this study that involved having patients that come to the ED for a fall, seeing both a physical therapist. To kind of address those things that I've listed. And then a pharmacist to look at polypharmacy and fall risk increasing medications. And like lo and behold, the intervention worked. We were able to reduce recurrent EV visits for falls by 66%.

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Chapters

6 chapters

1 What motivated the hosts to explore embedding geriatric care in the emergency department? 0:00–4:53 2 How did Liz Goldberg’s experience with fall patients lead to the creation of GAPcare? 4:53–11:45 3 What does the GAPcare model include and how is it triggered for older adults who fall? 11:45–19:59 4 How did Lauren Southerland bring the Office of Aging services directly into the ED? 19:59–26:57 5 What were the key outcomes of the GAPcare pilot and subsequent studies? 26:57–37:23 6 What challenges and push‑back have teams faced when embedding services in the ED? 37:23–47:13

Speakers

3 identified

Alex Smith 5 min Eric Widera 5 min Jack Clark

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Topics in this episode

Alex Smith 1 Eric Widera 1 John Mayer 1 Ohio State University 1 University of Colorado 1 Jags 1 gravity 1 Rochelle Bernacki 1 Rebecca Goldstein 1 Elizabeth Cobbs 1 Meg Walhagen 1 Carol Dietrich 1

Source

Recorded12 Feb 2026

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524473

Show notes

The idea of embedding various forms of non-emergency care in the emergency department makes a WORLD of sense. If an older adult comes into the ED with a fall, the minimum the ED has to do is address the fall injury and send them out. But many emergency providers realize this is often a band aid. They see that patient again the next time they fall. And again. And again. The same could be said for the patient who is malnourished and dehydrated and admitted for "failure to thrive," again. And again. Our two guests today, Liz Goldberg and Lauren Southerland, both emergency medicine physician-researchers, have had enough. On our podcast today they discuss how these sorts of experiences led them to argue that other services that can address the underlying causes that lead to ED visits. Liz Goldberg developed the GAPcare model to address falls, which includes a physical therapist and pharmacist seeing patients on the spot in the ED. Lauren Southerland got Columbus Ohio Office of Aging staff to re-locate from their desks to the emergency department, where they could sign patients up for home delivered meals, medical transportation, adult day services, home modification such as grab bars, and utility assistance for electricity, gas, and water bills. With GAPcare, Liz saw a 66% drop in ED visits for fall over 6 months from her pilot (subsequent fall outcomes of the GAPcare II study will be linked here when published). Remarkable, particularly in the context of the primary care STRIDE intervention, which did not reduce injurious falls (e.g. the type that would result in an ED visit). Maybe the ED is just a better place to intervene? Patients are motivated to change. Get the physical therapist and pharmacist in there! In a study published in JAGS, Lauren found 50% of participants were linked to a new Office of Aging service initiated during the ED visit, with no increase in ED length of stay or hospital admission rate. See also this terrific JAGS editorial on Lauren's paper by Liz. Putting on my JAGS editor hat - both the study and editorial have terrific color figures. A great way to increase your odds of review and acceptance at JAGS is to include one or more high-impact color figures that convey the main findings or points of your manuscript. We talk about the potential downsides, real and perceived in embedding care in the ED. Should everything be embedded? We talk about how these interventions relate to geriatric ED certification. Lauren talks about a remarkable model in Australia that includes a geriatric RN embedded in the ED. Most encouraging is that Liz and Lauren are finding other adopting these interventions. Word is spreading. Other emergency providers have had enough of the endless cycle. Enough. And I got to belt out Gravity, by John Mayer! -Alex

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