The Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program targets potentially inappropriate medication (PIM) prescribing among older adults discharged from the emergency department (ED). This study examined two implementation approaches to scaling up EQUIPPED at four EDs (one ‘traditional’ site and three ‘hub-and-spoke’ sites). After implementation, PIM prescribing declined significantly at all four EDs, indicating that the hub-and-spoke model can offer a new and effective approach to spread a scaled-up EQUIPPED program.