ACEP's New Geriatric Emergency Department Accreditation Program Takes Off in First Year

Elderly patients with chronic conditions are increasingly ending up in emergency departments around the country, according to a new study. And those same patients end up getting admitted or transferred more often and requiring more treatment and resources than their less-afflicted counterparts.

“Older patients are more likely to have multiple chronic conditions, which makes emergency care increasingly complex,” said lead author Dr. Edward Castillo, associate adjunct professor in the department of emergency medicine at the University of California, San Diego. “A better understanding of older patients opens the door for interventions in and beyond the emergency department [ED].”

Geriatric Emergency Medicine

His suggestion? Enhancing delivery and decreasing utilization for seniors, which also is the goal of the American College of Emergency Physicians’ (ACEP) new Geriatric Emergency Department Accreditation Program. Launched in May 2018, the GEDA program promotes quality care for older adult patients, including transitions of care, quality improvement and outcomes, and more efficient preparation of the treatment area. The GEDA program comes just four years ACEP and other healthcare organizations established the Geriatric Emergency Department Guidelines, which began the process of addressing “ the unprecedented and overwhelming challenge to the American health care system and emergency departments that the population explosion among seniors presents.”

According to a 2013 RAND report, approximately 60 percent of Medicare patients admitted to the hospital arrive through the emergency department. As well, multiple studies in Annals of Emergency Medicine note the vulnerability of older adults after an emergency visit. All of which points to an opportunity for targeted care with elderly patients in mind.

“Older adults visit emergency departments at a high rate, they often present with multiple chronic conditions and face more social and physical challenges than the general population,” said Paul Kivela, MD, MBA, FACEP, former president of ACEP. “Seniors who visit ACEP accredited emergency departments can be assured that the facilities have the necessary expertise, equipment and personnel in place to provide optimal care. This initiative will greatly enhance geriatric emergency care, especially in rural areas, and help ease older patients back into their daily lives after an emergency occurs.”

One Hospital’s Experience

The new Gary and Mary West Emergency Department at UC San Diego’s Jacobs Medical Center, a Level 1 Gold GEDA accredited facility, officially opened its doors on January 2. However, the senior-focused care model isn’t new for this ED.

“Although we have been delivering specialized senior emergency care for more than two years, the new physical space allows older adults to be cared for in an environment that better meets their needs than a traditional emergency room setting,” said Vaishal Tolia, MD, MPH, medical director of the Department of Emergency Medicine at UC San Diego Health. “We are very excited to provide this unprecedented service to our senior patients and their caregivers.”

The accredited geriatric emergency department features architectural design elements for older patients, such as carefully calibrated lighting and improved acoustics, safety and comfort. The customized waiting room boasts chairs with high backs and sturdy arms and legs to assist seniors in sitting and standing. The 11 new SECU patient rooms are equipped with sound-absorbing walls and ceilings to reduce ambient noise; a variable lighting system that orients patients to the actual time of day; and contrasting colors between walls and floors and between toilet and chair seats, and floors improve mobility and reduce fall risk.

GEDA Accreditation

The GEDA program’s voluntary accreditation is broken down into three levels (similar to trauma designations) with specific criteria and goals for clinicians and administrators. Requirements begin with demonstrating that the participating emergency department (1) includes both a physician and nurse with specialized geriatric training on staff, (2) meets environmental criteria such as easy patient access to water and mobility aids and (3) has a geriatric quality improvement program.

When the program launched last spring, eight emergency departments were accredited as part of the GEDA pilot program, including the Gary and Mary West Emergency Department, which was one of the first EDs to achieve Level 1 Gold status. According to the GEDA website, there currently are 38 accredited EDs, including the following:

Ascension Columbia St Marys Hospital Ozaukee (WI)
Ascension Elmbrook Memorial Campus (WI)
Aurora Medical Center of Oshkosh (WI)
Aurora Sheboygan Memorial Medical Center (WI)
Aurora Sinai Medical Center (WI)
Aurora St. Luke’s South Shore Medical Center (WI)
Aurora West Allis Medical Center (WI)
Carle Foundation Hospital (IL)
Carroll Hospital Center (MD)
Chino Valley Medical Center (CA)
Covenant Medical Center (MI)
Dupont Hospital (IA)
The Gary and Mary West Emergency Department at University of California, San Diego Health, La Jolla (CA)
Highland Hospital (NY)
Holy Cross Hospital (FL)
JPS Health Network (TX)
Kuakini Medical Center (HI)
Littleton Adventist Hospitals (CO)
Missouri Baptist Medical Center (MO)
Molokai General Hospital (HI)
Morristown Medical Center (NJ)
The Mount Sinai Hospital (NY)
North Hawaii Community Hospital (HI)
Northwestern Memorial Hospital (IL)
The Ohio State Wexner Medical Center (OH)
Queen’s Medical Center (HI)
Queen’s Medical Center West O’Ahu (HI)
San Dimas Community Hospital (CA)
Spectrum Health Blodgett Hospital (MI)
St. Johns Pleasant Valley Hospital (CA)
St. Joseph’s University Medical Center (NJ)
St. Joseph Medical Center Kansas City (MO)
St. Mary Mercy Hospital (MI)
St. Mary’s Medical Center (MO)
Stanford University Hospital (CA)
Sturdy Memorial Hospital (MA)
Tufts Medical Center (MA)
UNC Medical Center Hillsborough (NC)