As he was pursuing his career in medicine, Dr. Chris Carpenter had chosen to specialize in internal medicine with the desire to become an interventional cardiologist.

But after witnessing his grandfather undergo many tests and procedures in the emergency department that did not account for his dementia, Carpenter developed the desire to improve emergency department visits for older adults.

“[I]t did shift my specialty and my career path,” Carpenter said in a recent interview for Washington University School of Medicine’s Show Me the Science podcast. “And it wasn’t just cognitive impairment that I was focused on. I’m focused on the big landscape of geriatric emergency care and the vulnerabilities that these patients have.”

This experience led Carpenter to pursue dual-board certification in internal medicine and emergency medicine, and to undertake research initiatives to seek ways to improve emergency department visits for older adults.

During his residency at Allegheny General Hospital in Pittsburgh, Carpenter received a resident research grant from the Emergency Medicine Foundation to develop a decision aid for clinicians to identify older adults who would be at an increased risk of a fall after an episode of emergency department care. The instrument is one of only two such tools derived in ED settings that exist for assessing fall risks.

For the past two decades, Carpenter has served as a faculty member in the Washington University School of Medicine in St. Louis, where he has continued his dedication to research and scholarship that evolves care for older adults in the emergency department.

From 2011 to 2014, Carpenter collaborated with fellow GEDC Core Faculty Member Dr. Ula Hwang to co-lead the development of the first Geriatric Emergency Department Guidelines endorsed by the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association and Society for Academic Emergency Medicine – and subsequently also endorsed by the Canadian Association of Emergency Physicians, American Academic of Emergency Medicine, and American College of Osteopathic Emergency Physicians. The GED Guidelines provide recommendations for emergency departments in matters of staffing, transitions of care, quality improvement, education, equipment and supplies, and policies, procedures and protocols to improve care for older adults.

Those guidelines paved the way for ACEP’s Geriatric Emergency Department Accreditation Program (GEDA), established in 2016. The program offers three different levels of accreditation to emergency departments, and as of February 2023, GEDA has awarded accreditation to 500 emergency departments worldwide.

Carpenter is currently co-leading revisions to the original GED Guidelines with a new approach based on GRADE methods used by over one hundred organizations worldwide, and modeled after the Society of Academic Emergency Medicine’s GRACE guidelines. GRADE stands for Grading of Recommendations, Assessment, Development, and Evaluations and serves as a framework for synthesizing evidence and making recommendations for clinical practice.

Carpenter led the development of the GRACE guidelines, which stand for Guidelines for Reasonable and Appropriate Care in the Emergency Department. They were designed to establish best practices for the most common chief complaints in emergency departments, with a pragmatic approach that emphasizes reducing needless testing while minimizing risk.

“I believe that the GRADE-based updates to the GED Guidelines will highlight how little high-quality evidence that we have currently upon which to base ED protocols for older adults (and to convince CMS funders to reimburse more age-friendly ED care),” Carpenter said.

Ultimately, Carpenter hopes this work will “generate the science needed to move the needle forward in clinical operations/reimbursement, education, and healthcare policy legislation.”