A Scarce Resource: Cleveland Clinic’s Innovative Geriatric ED Reduces Avoidable Admissions

Cleveland Clinic has implemented Geriatric Emergency Departments (GEDs) systemwide. GEDs address the unique and complex needs of older adult patients in emergency settings. Older adults often experience higher rates of admission and longer hospital stays due to vulnerabilities the current system is not designed to accommodate. Recognizing the challenges posed by high census and bed shortages, the GED model has been implemented in Cleveland Clinic’s 13 EDs as a strategy to prioritize the most vulnerable patients by improving care efficiency and patient outcomes. This includes standardized care protocols, early detection of delirium, and seamless care transitions, ensuring that only patients with the highest acuity are admitted, while others are safely transitioned back to their homes.

Cleveland Clinic’s approach incorporates various operational frameworks, such as dedicated geriatric units and the use of geriatric practitioners, to enhance the management of geriatric syndromes and reduce unnecessary admissions. Specifically, the inclusion of geriatric physicians in observation units has significantly lowered avoidable admissions by streamlining care processes and utilizing existing resources more effectively. These measures have not only improved throughput in the ED but have also facilitated additional professional billing opportunities and decreased the overall impact on ED operations, showcasing a scalable model for geriatric care.

The GED program at Cleveland Clinic has also yielded substantial cost savings through reduced Medicare expenditures and reduced lengths-of-stay for admitted patients. The program also enhances revenue through direct billing for geriatric services and increased referrals to outpatient clinics, underpinning a comprehensive approach to geriatric emergency care that balances clinical excellence with cost efficiency. This initiative not only underscores Cleveland Clinic’s commitment to innovative healthcare solutions but also sets a benchmark for the integration of geriatric care into emergency medicine nationally.