Introduces the basic concepts of quality improvement: structure, process, and outcomes; and the importance of considering them early in your developments. Explores the relevance of a Plan-Do-Study-Act cycle with examples from various Geriatric ED initiatives. Outlines some essential metrics that are relevant in every Geriatric ED and a process for tracking specific metrics within certain initiatives. Describes ways you can track your data – manual, chart review, data dashboard, electronic health record redesign.

Overview of this practical guide helping practicing ED interdisciplinary clinicians, ED leaders, and hospital administrators who are responsible for providing acute care to older adults to improve their care.

Suggests several strategies -- truth-mapping and demographic analysis and a review of structure, processes, and outcomes – to assess your current situation. Reviews the core people, the champions, whom you need to enlist. Introduces the essential combination of the 3 Ps – People, Processes, and Place; and two general approaches to physical design – a separate space or an integrated space. Outlines key background material to master and groundwork at your own hospital before starting any changes

Describes simple low-cost additions to the physical space of an ED organized around the patient’s sensory, mobility, and comfort needs. Emphasizes design thinking concepts to focus on the patient experience when making changes. Catalogues more extensive changes to the environment, working in circles out from the patient – to the room, the unit, the hospital. Counsels against the “quick fix” of building projects without the foundation of people and processes.

Provides a response to the standard arguments against a Geriatric ED: we don’t need it; we don’t have time, money, expertise; we don’t want it. Suggests some opportunities to get support: “what’s in it for me?” Provides some sample scripts to use with colleagues to move to “Yes, and . . .”

Describes the key roles of a Geriatric ED, the interdisciplinary team, who do the daily work and how they collaborate: physician, nurse care coordinator, physical and occupational therapists, social worker, pharmacist. Describes at length the central role of the nurse care coordinator, including leadership and capacity development. Presents options and opportunities for training and education of those key roles and for the frontline nurses and doctors. Revisits the importance of change champions – nurse, physician, executive – and how to engage them.

Defines protocol, policy, and process and their importance in creating the Geriatric ED. Presents nearly 30 different processes that you can adopt or adapt to move towards geriatric-focussed ED care. Screening; enhanced assessments; workflow changes; transitions of care; physical comfort. Encourages EDs to consider which are going to be both easiest to implement and which are going be highest impact.

Presents practical tips to help clinicians go from good to great in their approach to older patients. Reviews key skills, knowledge, and attitudes about older people that they probably didn’t learn in their training to add to their approach for better outcomes. Treat the person not the person’s age. Sit down. Talk slowly not loudly. Think broadly not algorithmically. Drugs, drugs, drugs. Go for a walk. Be a team player. Learn about frailty.

Provides a definition of a Geriatric Emergency Department: a regular general ED that has made the decision to intentionally implement changes in its people, processes, and place in order to improve the quality of care it provides to older patient. Reviews the principal motivations for a Geriatric ED: shifting demographics and a favorable business case for the hospital. Presents the basics of the business case with a return-on-investment consideration, demonstrating several sample scripts for talking to senior executives. Suggests the importance of involving frontline staff to establish the ground truth in your ED.

Describes the ACEP Geriatric ED Accreditation Program and how this guide can be used if preparing for it. Emphasizes that the scope of change may be small or large; pace may be gradual over years; or dramatic over a year. No wrong place to start; no wrong choices to make. Be bold.