“These are principles most emergency physicians understand and agree with. Yet most emergency departments in the United States lack access to geriatricians, geriatric care specialists, or even physical therapists.”
Emergency departments in New South Wales have received funding for geriatric specialists for more than a decade. Quality measures such as routine delirium screening have been in place since 2017. These policies are not aspirational; they are operationalized across diverse emergency care settings.
How Australian EDs Operationalize Geriatric Care
Each emergency department I visited implemented geriatric care differently. Some prioritized nurse specialists who worked closely with patients arriving from nursing facilities to ensure effective communication with families and long-term care staff. Others focused on preventing emergency department visits altogether by sending emergency clinicians to facilities to assess patients and obtain bloodwork and imaging on site. Several departments concentrated on community-dwelling older adults, building strong connections to home services. In one small rural hospital deep in the bushlands, I met a geriatric nurse who followed up with older patients in their homes or the area’s sole nursing facility after emergency visits. She knew most older adults in the community personally. Australian emergency medicine residents told me they could not imagine practicing without geriatric specialist teams. They described how impossible it would be to gather the necessary information and coordinate care without this support. Many were genuinely shocked to learn that most U.S. emergency departments lack similar resources.
Why the United States Lags Behind
So why aren’t American emergency departments able to operate this way? The answer lies largely in policy and funding. Australia’s progress required national initiatives and sustained statewide investment. In the United States, we know that high-quality geriatric emergency care reduces hospital admissions, return visits, and overall costs. Yet current funding structures do not sufficiently incentivize hospitals to prioritize care quality for older adults.
emergency departments in other countries. We need to approach global systems with humility and resist the assumption that American emergency departments always deliver the best care. While the United States pioneered emergency medicine as a specialty, we are not the only innovators. Systemic challenges—particularly a fragmented health care system and increasing for-profit pressures—have limited our ability to adapt care to patient needs.
The Centers for Medicare & Medicaid Services has begun to apply pressure through new quality measures, including the Age-Friendly Hospital Measure. This measure requires hospitals to attest to having policies related to delirium screening and improved care transitions for older patients. While currently an attestation, it is expected to factor into hospital incentive payment systems beginning in 2028.
A Broader Vision of What’s Possible
If your emergency department does not have access to physical therapists for fall-risk assessment, geriatric case managers for care coordination, or delirium prevention and management protocols, there are roughly two years to implement them—or your health system may face payment penalties. Resources such as the Academy of Geriatric Emergency Medicine and the Geriatric Emergency Department Accreditation program can provide guidance.
Emergency medicine physicianresearchers interested in applying for a Fulbright scholarship are welcome to reach out to me at lauren.southerland@osumc.edu.
If flying foxes with five-foot wingspans swooping overhead on summer evenings or swimming among batfish in the Great Barrier Reef are not reason enough to visit Australia, consider going to learn from its advances in emergency care. My Fulbright experience was life-altering and reshaped my vision of what emergency care can be.
ABOUT THE AUTHOR Dr. Southerland is an associate professor of emergency medicine at The Ohio State University.
Looking Beyond U.S. Borders
My experience in Australia reinforced how much we can learn from
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