Putting Patient Goals Into Practice
The first CMS domain focuses on obtaining patients’ healthcare goals and treatment preferences, so that clinical decision making can be as informed as possible. For Age-Friendly Health Systems (AFHS) and Geriatric EDs, this means asking the patient and/or caregivers what matters most, to align care plans with their priorities.
To apply this effectively in the emergency department (ED) the Geriatric Emergency Department Accreditation (GEDA) guidelines provide specific care processes. Continue exploring to learn how they support CMS requirements.
Domain 1 | AFHS 4Ms | GEDA
Making the Connections
Meeting the CMS Measure means having concrete processes rooted in evidence. The AFHS and GEDA frameworks provide exactly that. Discover how each approach aligns with Domain 1 — and brings value to your ED, hospital and health system.
Linking CMS with AFHS and GEDA
CMS Domain 1
Eliciting Patient Healthcare Goals
Aligns With IHI’s 4Ms
“What Matters Most”
Achieved Through GEDA Care Processes
F3: Eliciting “What Matters Most”
C1: Early Access to Palliative Care
Why It Matters
Shaping Smarter Care
By reliably identifying what matters most to older adults at the first point of contact, the ED becomes the place where smarter downstream care begins — rather than where problems are handed off. With this framework, health systems can better utilize resources, shorten length of stay, and improve throughput. That directly improves system performance, which supports a strong business case for care processes that align with Domain 1.
Explore Resources
We have a large library of resources to support hospitals and EDs as they work to meet the CMS Age-Friendly Hospital Measure.
Enhance your goals of care conversations, and manage your seriously ill older patients with a patient-centered approach. To support your work, we’ve curated a few relevant resources.
TOOLKIT
What Matters: Eliciting Patient Healthcare Goals and the CMS Hospital Measure
Strategies for eliciting patient healthcare goals in an emergency setting with complex older patients.
COURSE
GEM104 | End-of-Life and Symptom Management in the Older ED Patient
A one-hour AMA and ANCC accredited course covering disease trajectories and prognosis, goals of care conversations, and symptom management.
COURSE
SGE013 | Palliative and End-of-Life Care of the Older Adult
A 30-minute presentation on providing compassionate, clinically appropriate care for seriously ill older patients.
GEDA Care Processes
Ways to Implement Change
GEDA care processes are a practical way to operationalize CMS priorities in the ED. When it comes to Domain 1, they help emergency clinicians support the primary healthcare goals and values of older adults, while deepening collaboration with palliative care.
Interested in learning more about GEDA accreditation for your ED?
Applying These Processes?
You’re Meeting the Mark
By adopting GEDA Care Processes, you’re already contributing to your hospital’s objectives of meeting national standards. They operationalize Domain 1 while supporting age-appropriate standards — and strengthening system performance. That empowers geriatric care champions like you to advocate for the resources you need. It also helps position your ED as an essential partner in achieving system goals, rather than a pressured entry point.
Operationalizing Domain 1 also helps build the case for dedicated palliative support, so complex goals-of-care conversations don’t fall solely to ED staff. This allows your team to focus on time-sensitive clinical priorities, while still ensuring older adults receive expert care that aligns with their goals.
Subject Matter Expert
Payal Sud, MD, FACEP
Payal Sud, MD, FACEP, an Associate Professor of Emergency Medicine and a Medical Toxicologist, is a leading voice in Geriatric Emergency Medicine (GEM). As Chief of GEM for Northwell Health and Associate Chairperson of Emergency Medicine at North Shore University Hospital, she works to optimize patient flow in the emergency department (ED) based on what matters most to older adults and caregivers.
Beyond her administrative work, Dr. Sud investigates the impact of early Palliative Care in the ED, and conducts NIH-funded research on ED care for older adults with delirium and dementia. Applying her extensive experience leading successful GEM initiatives, Dr. Sud now helps shape national standards as a reviewer for ACEP’s GEDA program.
