Concepts in Practice: Geriatric Emergency Departments

Southerland LT, Lo AX, Biese K, Arendts G, Banerjee J, Hwang U, Dresden S, Argento V, Kennedy M, Shenvi CL, Carpenter CR

Contributing GEDC Faculty

Chris Carpenter

MD, MSC, FACEP, FAAEM
Bio

Dr. Chris Carpenter is dual-board certified in Emergency Medicine and Internal Medicine and is Professor in Emergency Medicine at Washington University in St. Louis. His funded research interests include diagnostics, dementia, falls prevention, and implementation science. He is on the Society of Academic Emergency Medicine Board of Directors as well as the American College of Emergency Physicians Clinical Policy Committee. He is also Deputy Editor-in-Chief of Academic Emergency Medicine, Associate Editor of both Annals of Internal Medicine’s ACP Journal Club and the Journal of the American Geriatrics Society. He co-led the collaboration to develop the American College of Emergency Physician/American Geriatrics Society Geriatric Emergency Department Guidelines As well as the International Standards for Reporting of Implementation Research (StaRI) reporting guidelines. He is also faculty for Emergency Medical Abstracts and Best Evidence in Emergency Medicine courses, as well as a contributor to Skeptics Guide to Emergency Medicine and Sketchy EBM.

Abstract

In 2018, the American College of Emergency Physicians (ACEP) began accrediting facilities as “geriatric emergency departments” (EDs) according to adherence to the multiorganizational guidelines published in 2014. The guidelines were developed to help every ED improve its care of older adults. The geriatric ED guideline recommendations span the care continuum from out-of-hospital care, ED staffing, protocols, infrastructure, and transitions to outpatient care. Hospitals interested in making their EDs more geriatric friendly thus face the challenge of adopting, adapting, and implementing extensive guideline recommendations in a cost-effective manner and within the capabilities of their facilities and staff. Because all innovation is at heart local and must function within the constraints of local resources, different hospital systems have developed implementation processes for the geriatric ED guidelines according to their differing institutional capabilities and resources. This article describes 4 geriatric ED models of care to provide practical examples and guidance for institutions considering developing geriatric EDs: a geriatric ED–specific unit, geriatrics practitioner models, geriatric champions, and geriatric-focused observation units. The advantages and limitations of each model are compared and examples of specific institutions and their operational metrics are provided.

Full text at ScienceDirect