Leading the Way in Geriatric Emergency Care: The VA’s Patient-Centered Innovation

The Department of Veterans Affairs (VA) is on a transformative journey leading the nation in geriatric emergency care, dedicated to providing patient-centered care initiated in VA Emergency Departments (ED). The catalyst for this journey was a compelling demographic trend, marked by a notably older adult patient population. Within the Veterans Health Administration (VHA), 50% of patients seen in the ED are 65 years and older, more than double the rate seen at non-VA hospitals. On this systemwide journey, VA collaborated closely with the West Health Institute (WHI), the John A. Hartford Foundation and the American College of Emergency Physicians (ACEP), united in a commitment to elevate geriatric emergency care and patient-centered innovation for older veterans. VA's commitment to this goal set the stage for a profound story of health care innovation.

Challenges In Geriatric Emergency Care

Older adults often present to the ED with multi-faceted social needs or medical complaints related to delirium, cognitive impairment, polypharmacy and falls.

When compared to younger patients, the increased complexity of care required for older patients can lead to longer ED length of stay, higher risk of functional decline, increased ED boarding times and overall increased health care costs, which can have system wide impacts. 

VA's Commitment

In 2018, the VA National Office of Emergency Medicine, in collaboration with the VA Office of Geriatrics & Extended Care, initiated a systemwide investment in Geriatric Emergency Departments (GEDs), implementing a specialized care framework tailored to older adults in the emergency department. Research indicates numerous benefits of GEDs, such as reduced admissions, shorter in-hospital stays, increased screenings for at-risk adults, and lower overall costs.

VA has emerged as the largest Geriatric Emergency Department Accredited Health System, with 67 accredited GEDs, representing 61% of VA EDs nationally. This accomplishment underscores VA's commitment to provide enhanced care to Veterans.

Alignment with VA's Strategic Goals

Staff Perspectives On Geriatric Emergency Department Accreditation

To promote and sustain staff engagement, VA sought clinician perspectives on GED implementation. Insights from frontline staff and VA leadership highlight GED's impact on facilitating transitions to post-discharge care, streamlining ED processes, and enhancing patient well-being. Despite staffing challenges, frontline clinicians emphasize GED's role in fostering collaboration and patient-centered care. VA leadership sees potential staffing benefits, including using GEDs to recruit EM staff passionate about serving older veterans. Both groups recognize benefits such as standardized screening and improved patient and staff education. GED is viewed as integral to improving geriatric care across VA. Overall, GED Accreditation plays a central role in a larger goal: enhancing geriatric care and engaging health care professionals across the VA system.

Continued Sustainment & Future Direction

The path forward involves a commitment to expanding and ultimately accrediting Geriatric Emergency Departments (GEDs) across all VA EDs. This strategic approach includes enhancing connectivity with external geriatric initiatives and spotlighting the distinct value proposition of geriatric-specific programming in EDs. This trajectory aims to solidify VA's position as the premier health care provider for all Veterans. VA is committed to providing dedicated support for VA EDs to attain, sustain and advance their geriatric accreditation status. Looking ahead, the focus shifts to a meticulous analysis aimed at identifying the most impactful assessments and interventions for clinical efficacy, efficiency, and the delivery of value-based care from the ED, ensuring the unique care needs of older Veterans are met. This forward-looking framework encapsulates VA’s commitment to elevate the quality of care for our nation's Veterans.

For more information, please visit www.va.gov