Creating Age-Friendly Health Systems: Implementing Decision Support in the ED to Improve Geriatric Prescribing Practices


Scaling and disseminating a CDS system that provides physicians with targeted medication information may enhance safe prescribing practices for geriatric patients in the ED.

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Suboptimal prescribing can result in repeated ED visits, hospitalizations, or other adverse events

Older adults, particularly those prescribed new medications upon discharge from an ED visit, are at an increased risk of adverse drug events (ADEs). Preventable suboptimal prescribing can result in repeated ED visits, hospitalizations, or other adverse events. Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) is a previously validated CDS tool developed to reduce PIMs prescribed in the ED for adults aged 65 years and older. While it is currently in use at 20 Veterans Administration Hospitals and three community hospitals, Dr. Ann Vandenberg of Emory University wants to scale and disseminate EQUIPPED to three additional EDs and a new EHR platform not previously used with the EQUIPPED tool.

Using CDS to improve quality of prescribing in the ED

Dr. Vandenberg describes the ED environment as “busy, with a lot of interruptions and transitions,” while ED physicians have limited training in geriatric medicine. To help facilitate safe prescribing practices for clinicians, EQUIPPED offers education sessions on geriatric clinical prescribing guidelines, customizable pharmacy order sets, and monthly performance evaluation tools that are refined based on clinical and local data. Data from previous EQUIPPED implementations show a significant and sustained reduction in the average monthly PIMs prescribed at the time of discharge. Dr. Vandenberg is confident the EDs implementing EQUIPPED in this project will have similar results.

“Some drugs are not as effective or have adverse risks for older adults, but some providers do not know that. This project will really raise awareness of this issue.”
– Dr. Vandenberg

A multi-disciplinary approach to ED safety

Dr. Vandenberg feels the most significant aspect of this research is how it will spread the principles of geriatric medicine into spaces where they might not be as common. “EQUIPPED is part of a movement to create age-friendly health systems,” Dr. Vandenberg explains. With a rapidly aging population, she wants older adults in the United States to know that researchers and clinicians are “looking after them and equipping the ED to protect them.”