A new national quality improvement framework aimed at ensuring that every older person receives safe, timely and respectful emergency care, regardless of when or where they attend, has been published by the National Clinical Programme for Emergency Medicine at RCSI.

The framework was developed in response to the steady and sustained increase in emergency department and injury unit attendances by older adults. In 2025, more than 560 people aged 75 years and over present to emergency departments nationally each day, reflecting the evolving patterns of emergency care demand.

The framework is informed by national data and earlier work led by the National Clinical Programme for Emergency Medicine, which highlighted that many patients aged 75 and over are triaged to lower acuity categories despite complex clinical needs, often resulting in prolonged Emergency Department stays and delayed care.

The National Quality Improvement Framework (QIF) for the Care of Older Adults in Emergency Departments and Injury Units sets out a structured, evidence-informed approach, translating national policy and international standards into practical actions that can be implemented at site level, even in the context of ongoing system pressures. By strengthening post-triage assessment and standardising age-attuned practices, the framework aims to improve patient experience and outcomes while supporting more effective use of existing resources.

Dr Rosa McNamara, Clinical Lead, National Clinical Programme for Emergency Medicine said that “providing emergency care to older adults is a core responsibility of emergency departments and injury units. As we evolve to meet the changing needs of the populations we serve, this document offers clear guidance and direction on minimum standards, best practices, and aspirational care.”

Professor Deborah McNamara, President, RCSI, welcomed the publication of the framework: “Ireland’s ageing population is reshaping the demand for emergency care, and our health services must evolve accordingly. This Quality Improvement Framework provides practical, evidence-informed guidance to support emergency departments and injury units in delivering safe, timely and respectful care for older adults. RCSI is proud to support this important step towards more age-attuned emergency services nationwide.”

The framework builds on the Emergency Medicine Programme Model of Care (HSE, 2025) and aligns with Delivering an Age-Friendly Health System (Department of Health and HSE, 2025), as well as international best practice outlined by the International Federation for Emergency Medicine (IFEM). The framework focuses on three priority areas:

• Minimum care standards to ensure that all older adults have access to essentials such as hydration, appropriate seating, timely clinical assessment and clearly documented discharge and follow-up plans.
• Post-triage assessment and bundles of care, including frailty and delirium screening, to support early identification of risk, prompt intervention and avoidance of deterioration during emergency department stays.
• Education and workforce development, promoting geriatric emergency medicine-focused training for all emergency department staff, supported by dedicated clinical leads and simulation-based learning.

The framework provides clarity on core requirements while allowing flexibility for local adaptation. Accompanying tools and implementation resources have been developed to support sites in embedding improvements in a sustainable way.

Examples of effective practice already operating within Irish emergency departments and injury units demonstrate that meaningful improvements are achievable, even within constrained environments. Some of these case studies are featured in the document.

Under the National Clinical Programme for Emergency Medicine at RCSI, this Quality Improvement Framework and accompanying resources have been developed by frontline staff in emergency departments and injury units and provide a clear, practical pathway to consistently high-quality emergency care for older adults across Ireland.

This will support frontline teams to meet changing patient needs while remaining mindful of the significant pressures faced by emergency services.