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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.

 

Staffing

  • 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

Education

  • 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

  • Adherence to 10 components chosen in the Policies, Guidelines and Procedures section based on random chart audit

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

References

  • Kahn JH, Magauran BG, Olshaker JS, Shankar KN. Current Trends in Geriatric Emergency Medicine. Emerg Med Clin North Am. Aug 2016;34(3):435452.
  • Shaha M, Gmür S, Schoenenberger AW, Gerber FS, Exadaktylos AK. Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 20022012. Swiss Med Wkly. May 21 2015;145:w14141.
  • Carpenter CR, PlattsMills TF. Evolving prehospital, emergency department, and “inpatient” management models for geriatric emergencies. Clin Geriatr Med. Feb 2013;29(1):3147.
  • Keehan SP, Cuckler GA, Sisko AM, et al. National health expenditure projections, 201424: spending growth faster than recent trends. Health Aff. Aug 2015;34(8): 14071417.
  • Keehan SP, Poisal JA, Cuckler GA, et al. National Health Expenditure Projections, 201525: Economy, Prices, And Aging Expected To Shape Spending And Enrollment. Health Aff. Aug 2016;35(8):15221531.
  • Hwang U, Shah MN, Han JH, Carpenter CR, Siu AL, Adams JG. Transforming emergency care for older adults. Health Aff. Dec 2013;32(12):21162121.
  • Hogan TM, Losman ED, Carpenter CR, et al. Development of geriatric competencies for emergency medicine residents using an expert consensus process. Acad Emerg Med Mar 2010;17(3):316324.
  • Carpenter CR, Heard K, Wilber ST, et al. Research priorities for high-quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med. Jun 2011;18(6):644654.
  • Carpenter CR, Shah MN, Hustey FM, Heard K, Miller DK. High yield research opportunities in geriatric emergency medicine research: prehospital care, delirium, adverse drug events, and falls. J Gerontol Med Sci. Jul 2011;66(7):775783.
  • Rosenberg M, Carpenter CR, Bromley M, et al. Geriatric Emergency Department Guidelines. Ann Emerg Med. May 2014;63(5):e7e25.
  • Carpenter CR, Lo AX. Falling Behind? Understanding Implementation Science in Future Emergency Department Management Strategies for Geriatric Fall Prevention. Acad Emerg Med. Apr 2015 22(4):478480.
  • Carpenter CR, Griffey RT, Stark S, Coopersmith CM, Gage BF. Physician and Nurse Acceptance of Geriatric Technicians to Screen for Geriatric Syndromes in the Emergency Department. West J Emerg Med. Dec 2011;12(4):489495.
  • Han JH, Zimmerman EE, Cutler N, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med. Mar 2009;16(3):193200.
  • Tirrell G, Srion J, Lipsitz LA, Camargo CA, Kabrhel C, Liu SW. Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines. Acad Emerg Med. Apr 2015 22(4):461467.
  • Hogan TM, Olade TO, Carpenter CR. A profile of acute care in an aging America: snowball sample identification and characterization of United States geriatric emergency departments in 2013. Acad Emerg Med. Mar 2014 21(3):337346.
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