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Accreditation Levels - Silver

Silver - Level 2 Icon
Accreditation Levels - Silver Seal

Level Two has integrated and sustained senior care initiatives into daily operations. They demonstrate interdisciplinary cooperation for delivery of senior services. They have an established supervisor or director coordinating the people who are tasked with the daily performance of these services.



  • 1 MD or DO with evidence of 6 hours of focused education for geriatric EM
  • 1 RN with evidence of focused education for geriatric EM
  • Physician champion/Medical director
  • Nurse case manager/transitional care nurse present > 56 hrs/week
  • Interdisciplinary geriatric assessment team includes at least 2 roles
  • At least executive/administrative sponsor supervising the geriatric ED program

Equipment and Supplies


  • Staff physician education related to 8 domains of GEM
    View PDF: List of 8 Domains
  • Nursing education in geriatric emergency care (i.e., GENE, NICHE)

Quality Improvement

  • Demonstrate adherence to the 10 care processes below based on random chart audits as well as the three boarding care processes.

Care Processes, Policies, Guidelines and Procedures

  • Required 7 geriatric care processes plus the three baseline required standard of care processes (urinary catheter minimization, NPO status minimization, and physical restraint minimization) from the GED model of care for a total of 10 care processes. 
    View PDF: ED Model of Care 

Outcomes Measures

Physical Environment

  • Easy access to food/drink 24/7
  • 2 chairs per patient bed
  • Large analog clock


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  • Carpenter CR, PlattsMills TF. Evolving prehospital, emergency department, and “inpatient” management models for geriatric emergencies. Clin Geriatr Med. Feb 2013;29(1):3147.
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