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The Value of Geriatric EDs

How Geriatric EDs benefit patients, hospitals, and health systems

Resources for Making the Case

Download our slide deck to help you make the case to your C-Suite or Board of Directors for investment in geriatric-friendly quality improvement processes.

The Value of Geriatric ED Care

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Why GEDs Matter

Serving an Aging Population

Older adults engage with the healthcare system across many touchpoints, but none quite so frequent or consequential as the ED. Today, ED patients aged 65 and over account for a disproportionate number of potentially avoidable hospital admissions. That’s because the population is rapidly aging, and the healthcare system is under tremendous pressure to provide the necessary care.

A Look at the Numbers

10,000

Baby Boomers in the U.S. turn 65 every day.

29 M

Annual ED visits were made by patients aged 60+ (2014-2017)

46%

Of all ED visits resulting in hospitalization are for older adults

60%

Of avoidable hospital admissions are for patients 65+

Understanding the Fundamentals

What Is a Geriatric ED?

A geriatric ED may be either a separate space designated for older adults, or more likely, the integration of best practices for older adults into an existing ED. Similar to pediatric emergency departments, geriatric emergency departments provide specialized care to a population with unique needs.

GED Best Practices

  • Ensuring geriatric-focused education and interdisciplinary staffing
  • Providing standardized approaches to care that address common geriatric issues
  • Ensuring optimal transitions of care from the ED to other settings (inpatient, home, community-based care, rehabilitation, long-term care)
  • Promoting geriatric-focused quality improvement and enhancements of the physical environment and supplies

Why Geriatric Emergency Departments?

Older adults have different needs. See how geriatric care means better outcomes for patients like Mrs. Smith.

Watch Her Story

How a Geriatric ED Can Help Your Hospital

Implementing a geriatric ED comes with material benefits, both clinical and operational. Here’s how it can help your hospital or health system.

Decrease Admissions and Return Visits

  • Readmissions and returns to the ED for high-risk populations are lower in communities with Geriatric EDs3, 4
  • Senior-specific protocols in the ED are linked to reduced likelihood of admission from the ED2-4 without increasing mortality risk5-7

Improve Staff Satisfaction

  • Greater staff satisfaction reported in EDs with Geriatric Nurse Coordinator10
  • GEDs help staff know that they are doing an excellent job caring for their patients10

Increase Patient Satisfaction

  • Older adult patients who receive comprehensive geriatric assessment and geriatric-focused transition of care services report higher patient satisfaction9

Improve Census Management

  • Hospitals with Geriatric EDs have up to 16% fewer hospital admissions and a decreased inpatient length-of-stay for admitted older patients3
  • Geriatric-specific protocols in the ED are linked to reduced length of stay for admitted patients8

Increase Market Share

  • GEDs demonstrate a commitment to excellent care and improve management of existing patients by providing specialized care to those who need it8

GEDA Accreditation

Becoming a Geriatric ED

Earning formal recognition as a geriatric emergency department requires your ED to go through the Geriatric ED Accreditation (GEDA) program. GEDA was developed by leaders in emergency medicine to ensure older patients receive well-coordinated, quality care at the appropriate level at every ED encounter. It offers accreditation across three tiers.

Level 1 GED

Top level of accreditation. Gold standard of geriatric emergency care.

Level 2 GED

Excellent care processes and access to geriatric-specific resources.

Level 3 GED

Level of geriatric care obtainable by ALL U.S. Emergency Departments.

Interested in GEDA Accreditation?

There are 464 Accredited Sites (2023) and counting. Learn about how to become a GEDA-accredited emergency department today.

Visit GEDA

Investing in a Geriatric ED

Quality GED Care Pays Off

There are tangible reasons to invest in a geriatric ED. From clinical benefits to operational efficiencies, adopting a geriatric emergency care model improves patient outcomes while reducing preventable admissions and revisits. It can also strengthen your department’s reputation.

Improve Patient Outcomes and Satisfaction

  • Connect patients with community resources
  • Take steps to prevent potentially fatal conditions like delirium or iatrogenic conditions
  • Identify high-risk patients (frailty, polypharmacy, dementia, delirium)
  • Promote deprescribing

Enhance ED Operations and Market Share

  • Reduce hospital admissions
  • Prevent unnecessary admissions
  • Reduce ED 30-day and 60-day revisit rates
  • Leverage the interdisciplinary team
  • Improve staff satisfaction

Become Nationally Accredited as a Geriatric ED

  • Join a growing group of emergency departments providing excellent care for older adults
  • Access the Geriatric Emergency Department Collaborative (GEDC) for education and resources your clinicians can act on

Geriatric-Friendly Interventions

Proven GED Care Processes

Explore evidence-based care processes and the value they can bring EDs like yours.

Falls Intervention

Falls are common in older adults and often the reason we see them in our EDs. In fact, they are the leading cause of injury related morbidity and mortality among Americans aged 65 and older. As a result, they have led to over 2.8 million ED visits11 and $31.9 billion 12 in direct medical costs to Medicare annually.

In 2018, medical spending on non-fatal falls was about $49.6 billion. Overall medical spending on fatal falls was an estimated $754 million. By embedding a physical therapist, EDs can help mitigate the risk of falls and associated costs.

Value Breakdown
  • Starting salary for Physical Therapist: $76,303
  • Adjustment for taxes/benefits (*1.25): $95,378
  • Projected annual growth in ED PT visits: 217
  • Projected annual growth in outpatient PT visits (with an average of 4.2 visits/referral): 919
  • Average reimbursement rate: $176
  • Potential conservative estimate of revenue/charges generated: $199,936
Key Benefits
Fewer Return Visits

The odds of returning to the ED were 65% less for falls patients who received physical therapy vs. those who didn’t at both 30 and 60 days.

Reduced Costs


Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit.9

Geriatric Emergency Management (GEM) Nurse

GEM nurses are equipped to handle complex older adults arriving in the ED with atypical presentations, frailty, multi-morbidity, cognitive impairment, and polypharmacy.

Key Benefits

Geriatrics-focused emergency care quality improvement efforts administered by nurses trained in geriatric-focused assessments are associated with:

  • Decreased length of ED stay14
  • Reduced risk of hospital admission3, 13
  • Reduced risk of 30-day readmissions3, 13

Transitions of Care and Social Worker Consults in the ED

ED encounters are often sentinel events unmasking unmet social and functional needs. SW assessment is crucial to explore patients’ psychosocial needs and connecting patients with the proper community resources so they can safely return home and avoid unnecessary admissions.15

Care transition protocols improve disease management and are associated with reduced ED utilization.16

Key Benefits
Supports Aging in Place

Senior-specific protocols and enhanced transitions of care planning in the ED may reduce7 or delay SNF admission by 70%17, enabling seniors to age in place at reduced costs.  

Enables Medicare Savings


Receipt of care from GED TCNs and/or GED Social Workers (SWs) is associated with Medicare savings ranging from $2,436 to $2,905 per patient within 30 days after an initial ED visit. These savings are sustained at 60 days, ranging from $1,200 to $3,202.4   

Delirium Screening and Prevention

Delirium is common and serious. Of the nearly 20 million older adults seen in the ED each year12, approximately 8-17%18 present to the ED suffering from this potentially fatal condition. What’s more, 65-85%19 of the time, delirium is overlooked because it is not screened for. This is a major concern across the healthcare system, as patients with delirium have a 12-month mortality rate between 10-26%.20, 21

Adding to the challenge, delirium is costly. Older patients with delirium are at increased risk for inpatient falls, poor health outcomes, and greater healthcare utilization and expenditures.

Key Benefits
Prevents Delirium Incidence

EDs that screen for delirium and incorporate delirium prevention and management protocols help reduce missed delirium diagnoses and can even prevent this potentially fatal condition.

Reduces Hospital LOS

 

Dementia Screening and Prevention

Dementia is common among older adults and often undiagnosed. This complicates all stages of care in the ED from diagnosis to discharge.22

Incorporating dementia screening and follow up protocols for older adults is an important part of providing safe, effective care.

The ED also has the potential to play a role in connecting patients and caregivers to appropriate medical and social resources for management of dementia and other comorbidities.

Key Benefits
Prevents Delirium Incidence

Older adults with dementia are at an increased risk of developing delirium – a serious and sometimes fatal condition.20, 23  

Reduces Hospital LOS

Older adults with dementia are between 2.3 – 3.724 times more likely to revisit the ED within 30 days of index ED visit compared to older adults without dementia.21, 25  

 

Toolkit
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Discover How GEDA Strengthens CMS Compliance

GEDA care processes embed core tenets of the CMS Age-Friendly Hospital Measure into ED workflows. Explore how this helps improve geriatric emergency care while meeting national standards.

View CMS Support Guide
References
  1. WHI. Geriatric Emergency Department Factsheet (2013 HCUP-NEDS data). West Health Institute; 2017
  2. Stranges E, Stocks C. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008. Rockville, MD: Agency for Healthcare Research and Quality; 2010
  3. Hwang, U., Dresden, S.M., Rosenberg, M.S., Garrido, M.M., Loo, G., Sze, J., Gravenor, S., Courtney, D.M., Kang, R., Zhu, C.W., Vargas-Torres, C., Grudzen, C.R., Richardson, L.D. and (2018), Geriatric Emergency Department Innovations: Transitional Care Nurses and Hospital Use. J Am Geriatr Soc, 66: 459-466. https://doi.org/10.1111/jgs.15235
  4. Hwang U, Dresden SM, Vargas-Torres C, et al. Association of a Geriatric Emergency Department Innovation Program with Cost Outcomes Among Medicare Beneficiaries. JAMA Netw Open. 2021;4(3):e2037334. doi:10.1001/jamanetworkopen.2020.37334
  5. Wallis M, Marsden E, Taylor A, et al. The Geriatric Emergency Department Intervention model of care: a trial. BMC Geriatrics. 2018;18(1):297
  6. Spragmaticilvester KM, Mohammed MA, Harriman P, et al. Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources. Age and Ageing. 2014;43(4):472-477
  7. Ellis G, Whitehead MA, Robinson D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343
  8. Keene SE, Cameron-Comasco L. Implementation of a geriatric emergency medicine assessment team decreases hospital length of stay. Am J Emerg Med. 2022 May;55:45-50. doi: 10.1016/j.ajem.2022.02.027. Epub 2022 Feb 21. PMID: 35276545
  9. Lesser A, Israni J, Kent T, Ko KJ. Association Between Physical Therapy in the Emergency Department and Emergency Department Revisits for Older Adult Fallers: A Nationally Representative Analysis. J Am Geriatr Soc. 2018 Nov;66(11):2205-2212. doi: 10.1111/jgs.15469. Epub 2018 Aug 21. PMID: 30132800
  10. Guttman A, Afilalo M, Guttman R, Colacone A, Robitaille C, Lang E, Rosenthal S. An emergency department-based nurse discharge coordinator for elder patients: does it make a difference? Acad Emerg Med. 2004 Dec;11(12):1318-27. doi: 10.1197/j.aem.2004.07.006. Erratum in: Acad Emerg Med.2005 Jan;12(1):12. PMID: 15576523
  11. Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. 2016;65(37):993–998
  12. Burns E, Stevens J, Lee R. The direct costs of fatal and non-fatal falls among older adults – United States. J Safety Res. 2016;58:99-103
  13. Dresden SM, Hwang U, Garrido MM, et al. Geriatric emergency department innovations: the impact of transitional care nurses on 30-day readmissions for older adults. Acad Emerg Med. 2020;27(1):43-53. doi:10.1111/acem.13880
  14. Keyes DC, Singal B, Kropf CW, Fisk A. Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay. Ann Emerg Med. 2014;63(5):517-524. doi:10.1016/
  15. Sanon M, Hwang U, Abraham G, Goldhirsch S, Richardson LD, Investigators GW. ACE Model for Older Adults in ED. Geriatrics. 2019; 4(1):24. https://doi.org/10.3390/geriatrics4010024
  16. Wolinsky FD, Liu L, Miller TR, et al. Emergency Department Utilization Patterns Among Older Adults. The Journals of Gerontology: Series A. 2008;63(2):204-209
  17. Mion LC, Palmer RM, Meldon SW, et al. Case finding and referral model for emergency department elders: A randomized clinical trial. Annals of Emergency Medicine. 2003;41(1):57-68
  18. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet (London, England). 2014;383(9920):911-922
  19. Boucher V, Lamontagne ME, Nadeau A, et al. Unrecognized Incident Delirium in Older Emergency Department Patients. J Emerg Med 2019;57(4):535-542. doi:10.1016/j.jemermed.2019.05.024
  20. McCusker J, Cole M, Abrahamowicz M, et al. Delirium Predicts 12-Month Mortality. Archives of Internal Medicine. 2002;162(4):457-463
  21. Gower L, Gatewood M, Kang C. Emergency Department Management of Delirium in the Elderly Western Journal of Emergency Medicine 2012 2(13):194-201
  22. https://gedcollaborative.com/article/brain-health-in-the-ed-videos/
  23. Kakuma R, Du Fort GG, Arsenault L, et al. Delirium in Older Emergency Department Patients Discharged Home: Effect on Survival. Journal of the American Geriatrics Society. 2003;51(4):443-450
  24. LaMantia MA, Stump TE, Messina FC, et al. Emergency Department Use Among Older Adults With Dementia. Alzheimer disease and associated disorders. 2016;30(1):35-40
  25. Kent T, Lesser A, Howard J, et al. 30-Day Emergency Department Revisit Rates Among Medicare Beneficiaries With Dementia. Paper presented at: Society of Academic Emergency Medicine 2018; Indianapolis, IN
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