Inside a Geriatric ED: Stanford's Scalable Model for Older Adult Care

August 2025

Stanford Medicine’s Marc and Laura Andreessen Emergency Department has earned Level 1 Geriatric Emergency Department Accreditation (GEDA)—the highest designation awarded by the American College of Emergency Physicians.

The ACEP recognition caps a decade of system-wide innovation aimed at improving emergency care for the nation’s fastest-growing patient population: older adults.

With more than 2,000 emergency visits per month from patients over 65, Stanford’s approach offers a data-driven, interdisciplinary framework that other institutions can learn from and adapt.

“Older adults face unique vulnerabilities that demand a tailored, systematic approach to care,” said Dr. Michael Losak, medical director of the geriatric emergency department. 

As the U.S. population ages, emergency departments nationwide are seeing an increase in complex, age-related care needs. Traditional ED practices—such as long wait times, lack of mobility support, and high noise levels—can worsen health outcomes for older adults.

Stanford’s initiative is built on a simple but powerful premise: small, structural changes—applied consistently—can improve patient safety, reduce complications, and create a more humane care experience.

Rather than create a separate geriatric unit, Stanford chose to embed geriatric principles throughout its entire emergency department, ensuring equitable access to improved care for all older patients. “This isn’t about checking boxes,” said Losak. “It’s about designing systems that work—even when the attending physician is busy or not in the room.”

Some of the key innovations include:

• Overhauled delirium screening tools to improve diagnostic accuracy and completion rates
  

• Minimized unnecessary fasting (NPO) times via new protocols with radiology and anesthesia
  

• Catheter use reduction policy tied to physician and nurse documentation
  

• Fall-risk interventions and a custom-built frailty screening tool (GRAED)
  

• Physical modifications like non-slip flooring, analog clocks, and handrails
  

• Geriatric medication alerts integrated into Epic
  

• Large-font discharge instructions and automatic PCP notification workflows
  

• An age-friendly volunteer program to support cognition and reduce isolation
  

• Access to palliative care and 24/7 geriatric-trained case managers

A central tool in Stanford’s improvement effort is its real-time geriatric dashboard, which tracks dozens of metrics such as:

• Delirium screening rates
  

• Catheter usage
  

• Boarding times
  

• Palliative consults
  

• Fall bundle implementation
  

• Readmission and mortality rates

The dashboard supports monthly quality reviews, enables targeted interventions, and allows the department to measure progress transparently. For example, it helped the team reach zero catheter-associated infections in older adults over the past fiscal year and more than double its delirium screening rate.

One of the most transferable insights from Stanford’s experience is the role that accreditation can play—not as a bureaucratic hurdle, but as a strategic roadmap. By aligning departmental changes with GEDA standards, teams were able to accelerate projects, gain cross-departmental support, and push through complex builds in Epic and operations.

While Stanford’s size and resources are unique, many of the approaches are scalable and relevant for emergency departments of all types. Key recommendations from the team include:

• Use accreditation as a roadmap, not a checklist
  

• Engage interdisciplinary stakeholders early, including nurses, social workers, and community members
  

• Automate workflows in your EHR to ensure follow-through
  

• Start small—focus on a few high-impact metrics like delirium screening or fall prevention
  

• Build in feedback loops using dashboards or monthly committee reviews
  

Document and share progress to sustain momentum despite staff turnover

While much of the focus of the current accreditation is on care while in the emergency department, the team is considering care that extends beyond hospital walls.  Specifically, they are thinking about secondary prevention—ensuring that once a patient is treated for a fall or episode of delirium, steps are taken to prevent it from happening again. The team is also working to detect underreported issues, such as elder abuse and undiagnosed cognitive decline.

The department is now helping inform hospital-wide age-friendly initiatives and preparing for new CMS reporting requirements around older adult care. It is also considering the development of a multi-site research consortium to study and scale effective interventions in geriatric emergency medicine.

“This is a national conversation,” said Losak. “We want to collaborate with other EDs, share what we’ve learned, and build a research network that advances care for older adults everywhere.”

For Losak, this work is more than academic. Years before becoming a physician, his grandfather Hank—an important influence in his life— died after a preventable fall. The experience revealed the gaps in care that older adults often face.

“That loss stayed with me,” he said. “Now, I have a chance to help fix the national system that failed him.”