Date of Conferral

2-24-2026

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Sciences

Advisor

Dr. Kourtney Nieves

Abstract

Prolonged emergency department (ED) length of stay (LOS) among elderly patients is a complex and escalating challenge that calls for immediate strategic action from healthcare administrators seeking to improve outcomes and system efficiency. The purpose of this integrative review is to identify evidence-based strategies to optimize emergency department quality of care for elderly patients in acute hospital settings by examining systemic, clinical, and operational contributors to extended ED stays. A comprehensive review of literature published between 2021 and 2025 was conducted using systematic search and appraisal methods. Findings from the 12 peer-reviewed studies included in the final analysis were appraised using the Johns Hopkins Evidence-Based Practice (JHNEBP) appraisal tools to evaluate methodological quality and content relevance. Thematic analysis yielded four major themes and twelve subthemes. The primary themes included Capacity and Throughput Optimization; Workforce and Care Coordination Redesign; Geriatric-Centered Emergency Care Models; and Safety, Transitions, and Outcome Optimization. Key subthemes informing these domains included emergency department boarding reduction strategies, geriatric-sensitive triage processes, technology-enabled risk identification, and discharge transition planning. Guided by Donabedian’s structure–process–outcome model and general system theory, this review offers strategic recommendations to optimize throughput, integrate frailty screening, and reimagine ED processes with elderly care in mind. These changes have the potential to enhance patient safety, reduce health disparities, and restore dignity in the care delivered to aging adults in emergency settings.

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