Reach and Adoption of a Geriatric Emergency Department Accreditation Program in the United States

Abstract

The objectives of this study were to describe the reach and adoption of Geriatric Emergency Department Accreditation (GEDA) program and care processes instituted at accredited geriatric emergency departments (EDs).Methods: We analyzed a cross-section of a cohort of US EDs that received GEDA from May 2018 to March 2021. We obtained data from the American College of Emergency Physicians and publicly available sources. Data included GEDA level, geographic location, urban/rural designation, and care processes instituted. Frequencies and proportions and median and interquartile ranges were used to summarize categorical and continuous data, respectively.Results: Over the study period, 225 US geriatric ED accreditations were issued and included in our analysis-14 Level 1, 21 Level 2, and 190 Level 3 geriatric EDs; 5 geriatric EDs reapplied and received higher-level accreditation after initial accreditation at a lower level. Only 9 geriatric EDs were in rural regions. There was significant heterogeneity in protocols enacted at geriatric EDs; minimizing urinary catheter use and fall prevention were the most common. Conclusion:There has been rapid growth in geriatric EDs, driven by Level 3 accreditation. Most geriatric EDs are in urban areas, indicating the potential need for expansion beyond these areas. Future research evaluating the impact of GEDA on health care utilization and patient-oriented outcomes is needed.

Can we improve delirium prevention and treatment in the emergency department? A systematic review

“…Due to the prevalence of delirium in the ED setting and the associated morbidity and mortality, there is a growing support for ED‐based strategies to improve identification, management and prevention of delirium. Among accredited level 1 and level 2 geriatric EDs, 90% of level 1 and 40% of level 2 geriatric EDs reported protocols for delirium screening; in addition, many have implemented strategies to decrease delirium incidence 13 …”

The Geriatric Emergency Care Applied Research (GEAR) network approach: a protocol to advance stakeholder consensus and research priorities in geriatrics and dementia care in the emergency department

“…Recommendations to transform EDs to better care for older adults have included redesigning services and processes 4–6. Geriatric emergency care and geriatric EDs (GEDs) have emerged over the past decade as innovative solutions to better provide emergency care for older adults 4 6–8. However, many of the processes, protocols and care models targeting older patients with emergency care remain untested in the unique ED setting.…”

Developing a novel integrated geriatric palliative care consultation program for the emergency department

“… 22 To standardize care practices among geriatric EDs, the Geriatric Emergency Department Guidelines were published in 2014, followed by establishment of the Geriatric ED Accreditation program by the American College of Emergency Physicians in 2018. 23 The number of accredited geriatric EDs has grown rapidly under this program, and there are now over 300 accredited geriatric EDs in the United States. 24 There are 3 levels of geriatric ED accreditation, based on staffing, care processes, and equipment.…”

“… 24 There are 3 levels of geriatric ED accreditation, based on staffing, care processes, and equipment. 23 , 25 With respect to staffing, the lowest level of accreditation requires a physician and nurse champion. The next level adds dedicated case management as well as 2 of the following 4 disciplines: social workers, physical therapists, occupational therapists, and pharmacists.…”