Acute Care for Elderly
ACE(We certainly think we are)
Aim
Aim: To improve the care for over 85 year old acute geriatric patients by implementing an Acute Care for the Elderly model, as evidenced by –
• Decrease in Acute-Rehab LOS from 25 - 20 Days• Decrease in ACE LOS from 8.5 - 7 Days• Decrease in readmission rate from 6% - 4%• Decrease in step down of care rate from 14% - 8%
Overview of ACE
• What – Geriatrician led, comprehensive MDT care for acute elderly focusing on a sustainable return home
• Who – >85yo, acute admission, excludes specialist conditions, frail, complex needs
• How – Intensive MDT model, early screening, early and preventative rehab, comprehensive geriatric assessment, removal of a transition of care for those requiring rehab
• Why – Vulnerable patient group, higher readmissions, high rate of step down in care, unmet need
Challenges/Learnings
• Defining an “ACE” patient
Refining our acceptance criteria
• Getting ACE patients to the ward
Education
Operational shift
Culture change
• Understanding what we had changed and if our baseline was still relevant
Review of Baseline
50 patients per month
90 patients per month
150 patients per month
300 patients per month
Successes
• JaM tool – Quick identification of patients at risk of step down in care
Aim to get high value patients
• Admission screen
Facilitates combined MDT approach leading to combined care planning
• 9am Huddle
Improves regular ward communication and a team based approach
Summary Data to Date
Baseline Target 5 Month Average
7 day Re-admission rate
6% 4% 2.6%
Rate of step down of care
14% 8% 8.8%
Acute ALOS 7 days 7 days 8.5 days
Combined ALOS – ACE/AT&R
24.9 days 20 days 15.9 days
Acute to Rehab Journey >85’s
Acute to Rehab Journey >85’s
Baseline
24.9 days
Post ACE
16.9 days
• Mrs W – Chest infection, delirium, dementia, pressure area, reduced mobility
• Screening showed cognition declined, variable mobility, poor food intake
• Cared for by daughter – burn out, not engaged and didn’t have the skills
• Meeting with daughter/CN/SW
• Day care and respite arranged
• Daughter educated re pressure care,
feeding and spent time with
PT/Nursing to learn cares
• D/C home
Case Study