# Addressing Boarding in the Geriatric ED What's Inside? This toolkit provides tools, recommendations, guidelines, and educational resources for emergency departments (EDs) to implement processes that address the problem of boarding — and the risks it poses to older adults. It contains essential background and real-world examples of successful boarding protocols, so EDs can deliver consistent age-friendly care. Importantly, to assist you in championing new policies, this toolkit also includes a slide deck presenting the financial and patient-centred benefits of boarding reduction practices — all supported by clear evidence. The following resources will help staff and administrators make a case for implementing a care process that addresses boarding and the harm it may cause older adults. Take a moment to explore the materials that are most relevant to your practice. BLOG | December 18, 2025 Boarding Strategies and Harm Reduction | Framing the problem and the solutions An overview of the problem of boarding in the hospital and at the system level, and what can be done. Read Article JGEM | June 24, 2024 High Boarding Rates of Older Adults in the ED: An Ongoing Threat to Quality and Safety Since the 1980s, ED boarding has been recognized as a system-wide crisis. This article stresses the urgent need for policy-level changes that improve hospital and ED throughput. It also underscores the responsibility stakeholders share in advocating for meaningful interventions. Read Article Journal of the American Geriatrics Society | June 24, 2025 Boarding in Emergency Department Hallways Circa 2025: Why Older Adult Patients Deserve Better Boarding is not just an ED problem — it’s hospital-wide. This study delves into the lived experience of older adults boarding longer than 4 hours in ED hallways. It presents a real need for sweeping structural reforms, while highlighting ED-level improvements that have made a tangible impact. Read Article The Geriatric ED relies on an interdisciplinary team to manage the multimorbidity and complexity of frail older adults. Care coordinators, surge managers, social workers, GEM Nurses and other team members can be the key to a successful outcome of your QI process. To support you and your team, we are developing sample job descriptions that can be used by hospitals to assist in their hiring process. Check back in early 2026 for new content! GEM Nurse Champion Sample Job Description A sample GEM Nurse Champion job description that can be adapted for your ED. You can download a copy for your ease of use. Continue GEM Case Manager Sample Job Description A sample GEM Case Manager job description that can be adapted for your ED. You can download a copy for your ease of use. Continue Here, you can find excellent resources for understanding the causes and harms of boarding, and what can be done in the ED to help. Explore these materials and share them with your team. PODCAST | September 11, 2025 ED Boarding of Older Adults: Risks and Opportunities Deepen your learning with an episode of GEMCast, the Geriatric Emergency Medicine podcast from GEDC. This episode explores how to minimize the harmful consequences of boarding frail older adults in the ED. Listen Now PODCAST | December 18, 2025 Frailty Frontline: How to Identify Frailty and What to Do Next Deepen your learning with an episode of GEMCast, the Geriatric Emergency Medicine podcast from GEDC. This episode explores how identifying frailty in your older patients will help inform care processes and pathways. Listen Now For those who work in acute care, the ED boarding crisis is all too familiar. If you’re seeking to implement more intentional boarding processes in your facility, you may find the following materials helpful. They offer practical solutions to support care for older adults who board, and insights for managing challenging ED surges.  In addition, practices that reduce boarding address key elements of the CMS Age-Friendly Hospital Measure and Geriatric Emergency Department Accreditation standards. BLOG | December 18, 2025 Designing Care Processes to Reduce Boarding and Associated Harm Introducing care processes that address ED boarding takes persistence. Learn practical tips to make it happen. Explore Resource BLOG | December 15, 2025 Surge Plans for ED Overcrowding Planning for ED surges starts with understanding how they occur. Learn strategies for managing overcrowding in your hospital. Explore Resource Gaining an accurate assessment of older adults’ potential vulnerability is vital to enabling age-friendly care in the ED. With well-designed screening methods, you can ensure patients receive the consultations and support they need. The following material may be helpful as you work to optimize care processes that improve throughput. BLOG | October 22, 2025 Eliciting Healthcare Goals in the ED Working with patients to understand what they hope to gain during their visit is a critical task. Yet in a fast-paced ED, it can easily slip through the cracks. Learn how to frame conversations that uncover the primary worries and goals of older adults in your care. Explore Resource Dalhousie University Clinical Frailty Scale Dalhousie University’s Clinical Frailty Scale is an evaluated tool that summarizes overall fitness or frailty in older adults. It’s appropriate for use in the ED, and you can access it through the University’s website. Access Tool Having a care process that addresses boarding requires clear order sets that enable timely, consistent care. To help you optimize your ED workflow, this toolkit includes example order sets designed for older adults — available in Microsoft Word. Delirium Management and Prevention Example Order Set Download and customize this order set template, designed to help prevent and manage delirium in the ED. You can introduce it to your process as an add-on, or integrate it into other order sets as needed. Continue Contributors