# The Value of Geriatric EDs > A Geriatric Emergency Department comes with material benefits, both clinical and operational. Here’s how it can help your hospital or health system. 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. Make the Case Review the evidence for pharmacist involvement in the Emergency Department. investment in age-friendly care processes with a well-summarized pitch deck to share with your C-suite or board of directors. Continue The Value of Geriatric ED Care Access an editable slide deck designed to make the case. Download Slide Deck 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 The Value GEDA Brings See how GEDA accreditation has benefited hospitals and health systems across the country. Discover GEDA Success Stories 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     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 WHI. Geriatric Emergency Department Factsheet (2013 HCUP-NEDS data). West Health Institute; 2017 Stranges E, Stocks C. Potentially Preventable Hospitalizations for Acute and Chronic Conditions, 2008. Rockville, MD: Agency for Healthcare Research and Quality; 2010 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 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 Wallis M, Marsden E, Taylor A, et al. The Geriatric Emergency Department Intervention model of care: a trial. BMC Geriatrics. 2018;18(1):297 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 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 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 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 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 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 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 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 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/ 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 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 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 Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. Lancet (London, England). 2014;383(9920):911-922 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 McCusker J, Cole M, Abrahamowicz M, et al. Delirium Predicts 12-Month Mortality. Archives of Internal Medicine. 2002;162(4):457-463 Gower L, Gatewood M, Kang C. Emergency Department Management of Delirium in the Elderly Western Journal of Emergency Medicine 2012 2(13):194-201 https://gedcollaborative.com/article/brain-health-in-the-ed-videos/ 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 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 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