Accreditation Levels - Gold

Accreditation Level 3

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Level One defines an ED with policies, guidelines, procedures, and staff (both within the ED and throughout the institution) providing a coherent system of care targeting and measuring specific ED outcomes for older adults that form an overall elevation in ED operations and transitions of care both to and from the ED, all coordinated for the improved care of older adults. Additionally identified physical plant enhancements targeted to improve older adult care can exist.

Staffing

  • 1 MD or DO with evidence of 8 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 hours per week
  • Interdisciplinary geriatric assessment team includes 4 or more roles
  • At least 1 executive/administrative sponsor supervising the geriatric ED program
  • Patient advisor/patient council

Physical Environment

  • Easy access to food/drink 24/7
  • 2 chairs per patient bed
  • Large analog clock
  • Enhanced lighting
  • Efforts at noise reduction
  • Nonslip floors
  • Adequate handrails
  • High quality signage and wayfinding
  • Wheelchair accessible toilets
  • Availability of raised toilet seats

Equipment and Supplies

  • Access to mobility aids (canes, four-point walkers)
  • Access to the following 10 supplies (see Table 4 for list of supplies)
    View PDF: Equipment & 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)

Care Processes, Policies, Guidelines and Procedures

  • Required 17 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 20 care processes. 
    View PDF: ED Model of Care 

Quality Improvement

  • Adherence to 20 components chosen in the Policies, Guidelines and Procedures section based on random chart audit

Outcomes Measures

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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