Cameron Gettel MD MHS

1/ It’s been a struggle to process what happened at the CDC just a few days ago. The facts are coming in: one officer died, 500 rounds fired, 200 bullets made contact with 6 CDC buildings, hundreds of staff sheltered in place for hours. The intention is undeniable: this was an attempted massacre.

Just out in @agsjournal.bsky.social!
We developed and piloted an AI + care coach intervention to support ED-to-home transitions for people with dementia or cognitive impairment + their caregivers.

🧠↑ caregiver self-efficacy
📉↓ caregiver burden

Read more: doi.org/10.1111/jgs....

Patient Volume Requirements: Evaluation of the 2025 ACGME Proposal for Emergency Medicine Residency Programs Objectives The 2025 ACGME proposed that all EM residency programs must be 4 years and achieve a minimum of 3000 patients per resident. We characterize the current residency program patient volume pe...

📊 Our new study asks: Will ACGME’s 2025 proposal really boost EM resident experience? @saemonline.bsky.social

✅ 97% of programs already meet the 3000-patient volume
➡️ 3→4 yr shift barely changes volume exposure
🏥 Rural & urban programs look similar

Read more: doi.org/10.1002/aet2...
#EM #MedEd

Congrats to @camerongettel.bsky.social @agem-saem.bsky.social on developing a new care transition measure for older emergency department patients! The PROM-OTED score!

#SAEM25 @saemonline.bsky.social

These emergency rooms adapt to the needs of older adults Nobody wants to have to visit the emergency department, but "age-friendly" care seeks to make the experience safer for older people.

There's a trend to adapt #emergencydepartments to better meet the unique needs of our growing population of older adults.

Grateful to @ahascience.bsky.social and Mike Merschel for spotlighting this important shift!

#EMSky #GeriSky @acepnation.bsky.social
www.heart.org/en/news/2025...

I’m sorry for your loss Sarah - she sounds like an incredible woman and accomplished a great deal and positively influenced many lives in too short of a time

9/ @alzassociation.bsky.social @alzheimerssoc.bsky.social @istaart.bsky.social

#emergencydepartment #dementia #Alzheimers #cognitiveimpairment #EndAlz #medsky

8/ Bottom line:
✅ Screening for CI in the ED can work
🚫 Current diagnostic care transitions often break down
📈 Nearly 80% of those who followed up had confirmed CI

Let’s close the gap between detection and diagnosis - the ED can serve as a critical touchpoint.

7/ We see real promise in pairing cognitive screening with EHR automation. Risk models, auto-referrals, and prompts could lighten ED workload and reduce missed diagnoses. Future work should explore AI and EHR-enhanced pathways. We’re just scratching the surface.

6/ What could help?
• Options like home-based evaluations
• Tech support (e.g., EHR-based alerts or automated referral prompts)
• Risk stratification to prioritize patients needing urgent follow-up
• Public health campaigns to reduce stigma and promote follow-up

5/ Why the referral and follow-up rates are suboptimal:
• Dementia stigma—patients/families may avoid referral
• ED teams overwhelmed
• Fragmented systems, no clear outpatient path
• CI may limit follow-up, esp. without care partner
• Unclear who’s responsible for post-discharge follow-up

4/ The problem: despite effective screening and high follow-up yield, most at-risk patients weren’t referred or didn’t follow up. A huge missed opportunity - EDs are often the first touchpoint for undiagnosed CI. Early detection → timely treatment, caregiver support, better outcomes.

3/ Of those 100 referred, only 19 completed an outpatient cognitive evaluation – again a big drop. Among them:
🧠 79% were diagnosed with some form of CI
🧠 63% had probable dementia
💊 Many were prescribed meds for CI, dementia, or depression.

When the ED refers and patients follow-up…it matters.

2/ First, we screened 9,359 older adults in the ED for memory/thinking problems. ~5% of patients and 33% of care partners flagged possible CI – 650 in total were eligible for referral. Yet only 100 were actually referred. That’s a big drop – we’ll get to potential reasons for this in a bit.

🧵 1/ Check out our team’s new study in @alzdemjournals.bsky.social on ED-based cognitive impairment (CI) screening and referral. What we found highlights both promise and pain points in real-world detection and follow-up for CI and dementia in the acute care setting.

bit.ly/4cMO8M0

6/ This work is directly responsive to efforts from the multidisciplinary Geriatric Emergency care Applied Research (GEAR) network:

gearnetwork.org
pubmed.ncbi.nlm.nih.gov/34328674/

5/ 🏥 By providing insights into patients' perspectives on ED discharge and follow-up care, PROM-OTED can help health providers improve discharge processes and allow researchers to measure what matters to patients in future studies.

4/ ⏱️ With a mean completion time of just 5 minutes, the PROM-OTED tool can be administered via phone or electronically—making it feasible for diverse patient populations.

#GeriatricEmergencyMedicine #GeriEM #EmergencyMedicine #CareTransitions

3/ ✅ The final 18-item PROM-OTED tool measures critical aspects like understanding discharge instructions, medication management, follow-up care, and quality of life. It’s validated with excellent reliability and a robust factor structure.

2/ 🧑‍🔬 Our study involved 290 older adults (65+) discharged from EDs over 3 years, using qualitative interviews, item generation, and psychometric testing to create a reliable measure of care transition outcomes post-ED discharge. #PatientReportedOutcomes #EDCare

1/ 🚨 ED care transitions are critical for older adults, but no standardized tools have been available to measure patient-reported outcomes. Here we share the development and validation of the PROM-OTED tool to address this gap.

Access in @aem-journal.bsky.social: pubmed.ncbi.nlm.nih.gov/40155783/

Grateful to present with @camerongettel.bsky.social @manish-shah.bsky.social & others on how we are improving #dementia care in the #emergencydepartment.

#Geriatrics #EMSky @agem-saem.bsky.social

Register here: alz-org.zoom.us/webinar/regi...

Did a new Alzheimer's Disease drug keep this patient's brain healthier for longer? Sue Bell became one of the first Alzheimer's patients in the U.S. to receive the drug now marketed as Leqembi. Her husband isn't sure if it made a difference.

Sue Bell became one of the first Alzheimer's patients in the U.S. to receive the drug now marketed as Leqembi. Did it make a difference?

#alzsky #dementia #alzheimer #alzheimers #alz #sciencesky

10/ The big takeaway? Dementia care programs aren’t failing—they’re evolving. We must refine, target, & implement them better. GUIDE is an opportunity to learn from research & build a more effective, scalable system. Let’s get it right. 🚀🧠

9/ 🔹 D-CARE showed improved caregiver efficacy. GUIDE's focus on caregiver education & respite care may prove critical.
🔹 Hospitalizations & ED visits are modifiable. IN-PEACE showed this. A major reason to keep pushing for dementia-tailored care.

8/ 🔹 Targeting matters. Broad "one-size-fits-all" approaches may not work. Instead, models should be stepped, with different levels of care for early vs. late-stage dementia.
🔹 Implementation is key. Pragmatic trials are tough, esp. in COVID. GUIDE sites must be flexible & adaptive.

7/ Enter GUIDE, Medicare's new dementia care payment model launched in July 2024. It funds interdisciplinary teams, caregiver support, and 24/7 access to dementia expertise.

What should GUIDE take from D-CARE & IN-PEACE? 📌

6/ Subgroup findings suggest where dementia care can make an impact:
🔹D-CARE: Hints of benefit in caregiver self-efficacy in both intervention groups.
🔹IN-PEACE: Fewer ED visits/hospitalizations, esp. for African American patients & those with higher symptom burden.

Challenges and Innovations in Dementia Care Dementia, a neurodegenerative disease characterized by progressive cognitive and functional loss, is a devastating illness that requires a complex set of medical and social services for care. It is al...

5/ A key issue brought up in the associated Editorial: Neuropsychiatric symptoms as a primary outcome. These are distressing but highly variable. Should we instead focus on outcomes like hospitalizations or nursing home placement?

bit.ly/4aDoHLI