September 9, 2021
The Department of Veterans Affairs (VA) has launched a nationwide movement to improve emergency department (ED) care for older Veterans treated in VA Medical Centers and become the nation’s largest integrated health network with specialized geriatric emergency care.
The VA Geriatric Emergency Department Initiative is a public-private collaboration between the VA, the American College of Emergency Physicians (ACEP), The John A. Hartford Foundation, and the West Health Institute to establish 70 of the VA’s EDs as accredited geriatric emergency departments (GEDs). GEDs are better equipped to treat older adults with complex conditions, catch unmet care needs, and develop teamwork strategies to better coordinate emergency and follow-up care. Recent studies have found GEDs can decrease hospital admissions and lower total healthcare costs.
According to leadership at the VA, the initiative promotes Veteran goals of care, home safety, community emergency risk mitigation and preservation of Veteran independence.
“Nearly half of the nation’s 19.5 million Veterans are over 65 years old and account for more than 45% of ED visits at VA hospitals, more than double the ED visit rate for seniors nationwide,” said Steven L. Lieberman, MD, VA Acting Under Secretary for Health. “With COVID-19 highlighting the importance of geriatric emergency care around the world, through this initiative, VA continues to rise to the occasion by infusing age-friendly emergency care practices and improving care coordination in communities across the nation.”
Accreditation of VA Medical Centers is underway. Over the past year, an initial set of 20 EDs across 15 states applied for GED accreditation (full list below). To date, 16 have received accreditation, and the remaining four submissions are pending review.
“Geriatric-specific emergency care aligns with VA’s priority to provide age-friendly care to all older Veterans in all settings,” said Dr. Chad Kessler, National VA Emergency Medicine Director. “Partnering with the leading experts of geriatric emergency medicine, our emergency department teams are empowered to effectively meet the unique needs of our older Veterans and their caregivers and address what matters most to them. Geriatric emergency care programming identifies our most vulnerable Veterans, enhances their emergency care, and coordinates transitions of care through an interdisciplinary team approach from various services throughout their facilities.”
“Older adults visit emergency departments more frequently than other age groups and often manage multiple chronic conditions,” said Mark Rosenberg, DO, MBA, FACEP, FAAHPM, President of ACEP. “When you add the physical, mental or social challenges frequently faced by our Veterans to that equation it is easy to see that one size does not fit all—a specialized approach to emergency care for older Veterans can improve treatment and help our heroes lead healthier lives.”
“Emergency departments are a vital source of frontline care to older adults, including our older Veterans,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation. “Our goal is to take what we learn in VA emergency departments and scale it nationally, so all older adults get high-quality, age-friendly emergency care.”
“Our nation’s Veterans deserve the best care possible and to that end, we are proud to be partnering with the VA in a first-of-its-kind public-private initiative to establish accredited geriatric emergency departments across the VA system,” said Shelley Lyford, President and CEO of the West Health Institute. “It’s our hope that the 70 VA GED sites will serve as a role model for further system-wide adoption across the nation.”
Similar to trauma designations, voluntary accreditation is awarded across three levels. ACEP’s Geriatric ED Accreditation Program promotes more than two dozen best practices for geriatric emergency care. Since its inception in 2018, ACEP has accredited more than 260 EDs.
ACEP, The John A. Hartford Foundation, and the West Health Institute announced a 2-year extension of support in honor of the nation’s older Veterans. This extension will support a designated team to facilitate the accreditation of the remaining 50 VA EDs and upgrade 10 already accredited VA Medical Centers. Once accredited, all 70 EDs will deliver care in line with the Geriatric ED Accreditation Program and the Age-Friendly Health Systems framework, an evidence-based approach to care for older adults developed by The John A. Hartford Foundation and the Institute for Healthcare Improvement. The VA anticipates that all 70 sites will apply for accreditation by December 31, 2022.
The Geriatric Emergency Department Collaborative (GEDC), a national network of leading experts, hospitals, and professional organizations is also providing specialized training and assistance to the VA’s GED Initiative. The GEDC is a project supported by The John A. Hartford Foundation and the West Health Institute. Best practices and lessons learned from this collaboration will be shared with emergency departments across the country.