Abstract Background Frail older adults presenting to an acute setting are vulnerable to the adverse effects of hospitalisation including the risk of developing in-hospital delirium. Last year in Ireland the average ED waiting time for the >75 adult was over 13.8 hours and a stay 3 times longer than those >65. A stay of ten hours or more within the ED for the older adult will double the risk of developing in-hospital delirium within the following 72 hours. This can potentially result in the further risk of mortality, morbidity, and dependence for long term care. National Clinical Delirium Guidelines state that the management of delirium is primarily non-pharmacological. However, adequate access to these types of interventions is limited with in the ED. Methods The Frailty Intervention Team (FIT) completed Comprehensive Geriatric Assessment (CGA) with everyone over the age of 65 years old that attended the Emergency Department within hours of work. The 4 AT (Assessment Test for Delirium and Cognitive Impairment) was used to identify those who were delirious or at high risk of delirium. Once identified non-pharmacological strategies (orientation, early mobilisation, and comfort measures) were used to support the management of delirium. This was achieved by provision of seating, orientation clocks and a comfort trolley. Results Over 3-month period 64 patients reviewed by the FIT were highlighted as delirious or at risk of delirium. Once a patient was identified delirium protocol was followed and orientation, early mobilisation and comfort measure was provided by the FIT. 30 patients were facilitated to sit out in the ED through new provision of chairs. Conclusion A delirium friendly environment, appropriate seating and access to non-pharmacological therapies promotes quality of care, education and best practice in delirium management within the Emergency Department.