Implementing a Geriatrician-led Emergency Department Innovation: A CFIR-Informed Multidisciplinary Qualitative Study

Purpose : To examine factors influencing implementation of an embedded geriatrician model (Geriatric Emergency Department Innovation, GEDI) in a metropolitan Australian hospital. Methods : Semi-structured interviews were undertaken with 31 healthcare professionals to explore their experiences and perspectives of the GEDI model, including emergency physicians (n=5), emergency department (ED) nurse unit managers (n=4), geriatricians (n=5), ED pharmacists (n=5), care coordinators (n=8), and admitting physicians (n=4). Data were analysed using the Consolidated Framework for Implementation Research (CFIR) to explore determinants of adoption, workflow integration, and sustainability. Results : Participants reported that GEDI offered timely specialist geriatric input at the bedside, enabling rapid and holistic assessment and supporting collaborative decision-making across professional groups. However, operational challenges during implementation tempered the consistency and reach of this model. The inherent variability of ED presentations made standardized referral criteria impractical, leading to both missed opportunities and suboptimal referrals. Variable staffing and rotating junior doctors created awareness gaps about GEDI, compounding the referral problems. Sustainability was threatened by referral noise when scope was unclear, by early deferral referrals made before basic assessment, by capacity limits of a single geriatrician, and by rotating junior staff that created awareness gaps about GEDI. Conclusions : A geriatrician-led ED model can be integrated into routine workflows when supported by accessible specialist expertise and collaborative working practices. Implementation was influenced by contextual and organisational factors, suggesting that similar models may require local adaptation. Attention to role clarity, referral processes, onboarding of rotating clinicians, and service capacity may assist when considering this approach in other settings.