The emergence of “senior EDs” was highlighted within the context of crowding in a recent In the Arena column (“No Hors D’Oeuvres Please,” ACEP News, January 2012, p. 2; see also “Elder-Friendly EDs: A Future Standard?” ACEP News, September 2011, p. 1).

Aging baby boomers present an unprecedented challenge to emergency departments globally. However, this challenge can also be seen as an opportunity to improve emergency care for all patients because geriatric adults are the “canary in the coal mine,” highlighting obstacles to optimal outcomes within our systems of care.

While infrastructural changes produce a more geriatric-friendly ED, we believe the more important components of a senior ED are the personnel, training, and care transitions. All too often administrators have focused on the lighting, beds, floors, and noise level to promote their senior EDs. Many questions remain unaddressed by those who would simply restructure their physical plant, including:

• Who will staff these senior EDs? What training will these nurses, physicians, and extended care providers obtain to ensure that high-quality geriatric care and palliative care are being applied?
• How can EDs more efficiently and reliably coordinate transitions of care to and from the ED setting?
• Who will certify and monitor senior EDs?

As hospitals increasingly becoming interested in supporting improved emergency care for older adults, the American College of Emergency Physicians Geriatric Section (www.acep.org/content.aspx?id=25112) and the Society for Academic Emergency Medicine Academy of Geriatric Emergency Medicine (www.saem.org/academy-geriatric-emergency-medicine) are developing eight domains to improve patient care, safety, and outcomes in senior EDs: (1) structural enhancements, (2) operational enhancements, (3) staff education in geriatric patient care, (4) quality-of-care metrics, (5) coordination of hospital resources, (6) coordination of community resources, (7) staffing model assessment, and (8) geriatric-specific patient satisfaction improvement.

By coordinating ED, hospital, and community resources with streamlined transition-of-care models, we may improve cycle time, which in turn reduces crowding. A system designed for the frailest in our society will also benefit the strongest among us.

For more information on geriatric emergency departments, please join the AGEM meeting at SAEM on May 10, 2012, in Chicago, or ACEP’s Geriatric Section.

On behalf of the ACEP Geriatric Section and SAEM Academy of Geriatric Emergency Medicine,

Dr. Christopher R. Carpenter
Dr. Ula Hwang
Dr. Mark Rosenberg