ArticleAge and ageing2026
How a geriatrician-led emergency department model works in practice: a realist evaluation.
Article in Age and ageing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
- Erratum issued
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEmbedding 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.
objectiveTo develop programme theories explaining how, why, and under what conditions a geriatrician-led innovation model improves care for older people presenting to the ED.
methodsWe 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.
resultsSixteen 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.
conclusionsThis 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.
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