Last updated: November 2026
Geriatric emergency department accreditation readiness is the work of preparing an emergency department (ED) for the Geriatric Emergency Department Accreditation (GEDA) program run by the American College of Emergency Physicians (ACEP). Integral Healthcare Solutions (IHS) maps your department against ACEP's published criteria, drafts the care process write-ups, policies, process map and metric definitions for your physician and nurse leaders to approve, and runs a mock review before you apply.
ACEP decides your accreditation.
What is geriatric emergency department accreditation (GEDA)?
GEDA is ACEP's national accreditation program for the care of older adults in the ED. ACEP's FAQ frames the program as a way to improve older-adult emergency care through the physical setting, staff, written protocols and quality measurement (page opened 2026-11-06). ACEP's program page says a geriatric ED can be a dedicated unit, though adding older-adult practices to an existing ED is the more common route (page opened 2026-11-06).
The governing document is ACEP's Geriatric Emergency Department Criteria, which is marked as updated April 2024 (page opened 2026-11-06). ACEP's process page says criteria and process are subject to annual revision, so confirm the current edition with ACEP before relying on any count here.
What does each GEDA level require?
This table summarizes ACEP's Table 2 and FAQ in IHS's words (pages opened 2026-11-06; April 2024 edition).
| Level | Care processes | Staffing | Data and documents | Site visit |
|---|---|---|---|---|
| Level 3, Bronze | 4: the 3 required plus 1 selected | Physician champion (4 hours of geriatric emergency training); nurse champion | No additional tracking or outcome data to submit (the site still monitors its care processes); photo evidence of mobility aids and free food and drink | None |
| Level 2, Silver | 10: the 3 required plus 7 selected | Physician champion (6 hours); nurse champion; case manager or transitional care nurse, 56 hours a week; executive sponsor; 2 more roles | Process map; 3 months of evidence for 4 boarding metrics and 3 additional metrics | Possible if ACEP asks |
| Level 1, Gold | 20: the 3 required plus 17 selected | Physician champion (8 hours); nurse champion; case manager or transitional care nurse, 56 hours a week; executive sponsor; 4 more roles; patient advisor or council | Process map; dashboard; 3 months of evidence for 4 boarding metrics and 5 additional metrics | Required |
What makes a care process count for ACEP?
A care process has to be specific to older adults and specific to the ED. The criteria require three processes at every level for new and renewing sites since July 1, 2023: minimizing urinary catheter use, minimizing nil-per-os (NPO) status and minimizing physical restraint (page opened 2026-11-06). Sites choose more from ACEP's menu: medication safety, specialty consultation, screening (for example delirium, falls, elder abuse), transitions of care and boarding.
Each process needs a templated executive summary, a plan for monitoring adherence and a stated denominator; Levels 2 and 1 also submit an education plan. ACEP does not accept a write-up that leaves out either feature. A hospital-wide process needs a detailed written explanation of how it works for older adults in the ED, and an ED policy that treats all adults alike does not show the older-adult feature.
Since January 1, 2024, the criteria expect new and renewing Level 1 and 2 sites to track boarding of patients 65 and older after the decision to admit, against younger adults (ACEP's criteria give ages 19 to 64, its Silver and Gold level pages say 18 to 64, so confirm the range with ACEP): median time and the share boarding 4, 8 and 12 hours or more.
Who needs it and what triggers it
An ED needs this work when it wants ACEP's accreditation and cannot yet show geriatric-specific, ED-specific documents and data. Typical triggers:
- The hospital is preparing for the CMS Age Friendly Hospital measure, which covers the ED and names GEDA as a resource (below).
- A health system wants ACEP's system-level recognition, which the FAQ ties to at least 80 percent or 10 of its EDs holding awards within the same 3-year period, plus a system questionnaire and membership of ACEP's Geriatric Emergency Department Collaborative (page opened 2026-11-06).
- An accredited site is renewing or moving up a level.
How does GEDA relate to the CMS Age Friendly Hospital measure?
GEDA does not cover the whole measure. The measure is a hospital-wide attestation, and CMS's Table X leaves item 3C blank for GEDA. The Federal Register final rule says the measure "assesses hospital commitment to improving care for patients 65 years or older receiving services in the hospital, operating room, or emergency department" and CMS is "finalizing the Age Friendly Hospital measure as proposed beginning with the CY 2025 reporting period/FY 2027 payment determination" for the Hospital Inpatient Quality Reporting (IQR) Program (89 FR 69517, 69519, 69522, 69523 and 69525, August 28, 2024; read 2026-11-06).
The CMS specification has five domains, and CMS says a hospital earns a point for a domain only if it attests yes to all related sub-questions, with no partial credit (page opened 2026-11-06). Domain 3, item D, is the ED item: "Our hospital has protocols to reduce the risk of emergency department delirium by reducing length of emergency department stay with a goal of transferring a targeted percentage of older patients out of the emergency department within 8 hours of arrival and/or within 3 hours of the decision to admit."
The specification lists GEDA under its additional resources. CMS's attestation guide says attestation requires hospital-wide compliance for the majority, or 51 percent, of patients 65 and older, and says hospitals with limited resources may start small, such as with surgical patients or older adults in the emergency room. Its Table X marks GEDA as supporting every item except 3C (data on falls, pressure ulcers and readmissions), and item 5B only above Level 3 (page opened 2026-11-06). The final rule also says the IQR Program is pay-for-reporting: hospitals that attest to each domain, yes or no, are not subject to a payment reduction.
IHS's reading as of November 2026, not CMS's: GEDA's boarding metrics line up with item 3D, so one body of ED evidence can serve both. IHS did not read the FY 2027 IPPS final rule in full; confirm current requirements on QualityNet.
How IHS helps
The method:
- Gap assessment against the criteria for the level you are considering.
- Evidence index tying each requirement to the record that shows it.
- Drafts for your leaders to approve: care process executive summaries, ED-specific and geriatric-specific policies, process map, education plan, denominator and boarding-metric definitions, and champion job descriptions.
- Mock review of the application as an ACEP reviewer would read it, then readiness support until your hospital submits.
Your hospital supplies its policies, staffing schedules, boarding and screening data, equipment evidence, champion and sponsor names, and the ACEP materials it holds. The limit: IHS does not predict a level or ACEP's decision, does not apply for you and does not communicate with ACEP. Your hospital's named contact does.
What to have ready
These items come from ACEP's criteria (April 2024 edition; page opened 2026-11-06), in IHS's words.
| Item | What ACEP asks for |
|---|---|
| Physician champion | A board-certified emergency physician on staff who oversees geriatric operations, or co-directors if none can serve alone; where no emergency physician can serve even as co-director, hospital leadership requests an exemption to appoint a non-emergency physician for no more than three years |
| Nurse champion and job descriptions | A nurse who helps lead the team, with geriatric training certificates; ACEP's templated job description for each champion plus the official institutional one |
| Care process documents | One executive summary and one ED-specific, geriatric-specific policy for each process submitted |
| Denominators | A written definition of which patients count for each criterion |
| Team coverage (Levels 2 and 1) | 56 hours a week of case manager or transitional care nurse time; ACEP's pages differ on how much a social worker can cover |
| Data (Levels 2 and 1) | Three months of tracking, including the four boarding metrics, and a process map; a dashboard at Level 1 |
| Equipment | 24-hour access to mobility aids and to free food and drink (vending machines do not meet the food requirement); at Levels 2 and 1, also at least two visitor seats (ACEP's criteria say per room, its level pages say per patient bed) and a large-face analog clock in each patient room |
To walk the list against your records, start with the introductory call.
How it compares
GEDA is one of several routes. The Age-Friendly Health Systems initiative, which ACEP's FAQ links to its 4Ms framework, is covered on IHS's recognition page. The American College of Surgeons' Geriatric Surgery Verification program, which CMS's specification lists as aligned with the measure's domains, is covered on IHS's verification page. IHS does not tell you which to choose.
What it costs
ACEP's FAQ lists an application fee for each level, and the fee rises with the level (page opened 2026-11-06). Verify current fees with ACEP. The FAQ also says applicants arrange and reimburse the site visitor's expenses, while the process page calls the Level 1 visit virtual, so ask ACEP which applies.
IHS scopes each engagement after a free introductory call.
What this is not
IHS is not an accrediting body and does not grant GEDA accreditation or any level. ACEP states that meeting its criteria is a program qualification and not a statement of the legal or medical standard of care.
This page is not legal advice and does not tell a hospital how to answer a CMS attestation. IHS is a consulting firm, not a law firm. IHS does not guarantee a level or a decision.
Frequently asked questions
What is GEDA and who runs it?
GEDA is the Geriatric Emergency Department Accreditation program run by the American College of Emergency Physicians (ACEP). It accredits emergency departments at Level 3 Bronze, Level 2 Silver and Level 1 Gold. ACEP's reviewers and Board of Governors decide each application.
What do the three GEDA levels require?
Per ACEP's criteria (updated April 2024), every level needs 3 required care processes plus 1, 7 or 17 selected ones at Levels 3, 2 and 1. Level 1 adds a dashboard, a patient advisor and a site visit.
How long does GEDA accreditation take?
ACEP's pages give two answers. Its FAQ says about 10 to 12 weeks overall; its process page says 16 to 18 weeks after the application for Levels 2 and 3 and 8 weeks after the site visit for Level 1. Levels 2 and 1 also need three months of tracking data first. Confirm with ACEP.
Does my emergency department need a site visit?
Level 1 does, Level 3 does not, and Level 2 may be asked for one. ACEP's FAQ says the applicant arranges and reimburses the visitor's travel, while its process page calls the Level 1 visit virtual. Ask ACEP which applies.
What makes a care process count for GEDA?
It has to be specific to older adults and specific to the ED. ACEP accepts a hospital-wide process only with a detailed written explanation of how it works for older adults in the ED, and an ED policy that treats all adults alike does not meet the older-adult feature.
Does GEDA satisfy the CMS Age Friendly Hospital measure?
No. The CMS measure is a hospital-wide attestation, CMS's attestation guide leaves one item, 3C, blank for GEDA, and GEDA accredits one department. Your hospital decides its own yes or no answers.
What does IHS do, and what does it not do?
IHS drafts the care process write-ups, policies, process map, education plan and metric definitions, and runs a mock review. Your leaders approve clinical content and run the implementation. Your hospital applies and communicates with ACEP.
What does GEDA cost?
ACEP's FAQ lists an application fee for each level, and the fee rises with the level. Verify current fees with ACEP. IHS scopes each engagement after a free introductory call.