More than a year ago, leaders at Mount Sinai Hospital stared reality straight in the face: the population was aging. Two-thirds of the hospital’s medical patients were over the age of 65 and a new, holistic strategy was needed to care for older patients.
What came next was a series of programs, ideas and innovations, including the opening of the hospital’s Ben and Hilda Katz Acute Care for Elders Unit (ACE) in April 2011. Since opening its doors, this dedicated, patient-care area for frail older adults has transformed the lives of patients and staff alike. Jocelyn Bennett, Senior Director for Urgent and Critical Care, says the unit is already delivering better outcomes for these patients.
“With the ACE Strategy, we have developed something that is delivering patient-centred care in its truest sense. By seeing the whole person and going beyond their acute medical need, we are delivering the right care in the right place at the right time,” says Bennett.
While Mount Sinai was the first acute-care hospital in Canada to make geriatrics a core strategic priority in 2010, the tailor-made ACE Unit strengthened that promise. Aligning with an entire continuum of geriatric care, the hospital’s ACE Strategy ensures a patient’s journey through community, emergency, inpatient and outpatient settings is as integrated and seamless as possible.
The goal of the ACE Unit is to enhance geriatric care in General Internal Medicine by recognizing that older patients often enter hospital with several social and health care needs. In developing the 28-bed unit, an existing ward was converted to create an elder-friendly environment. The space includes large clocks to promote orientation, high back chairs, raised toilet seats and hearing and visually impaired-assistive telephones, among other pieces of specialized equipment aimed at maintaining function and independence for these older patients.
An inter-professional leadership team of geriatric-trained medical, nursing and allied health professionals run the new unit. The ACE Unit also partnered with the Toronto Central Community Care Access Centre (CCAC) to create the role of an ACE Unit Care Coordinator, a specialized role that helps transition patients back home.
In less than a year, the ACE Unit is already showing remarkable results. The team has been carefully monitoring its patient and system outcomes through independent surveys and measurements. The data is impressive. Compared to a year earlier, the use of urinary catheters, and the incidence of pressure ulcers have fallen. Patients’ lengths of stay have decreased and readmissions rates have been cut in half from 15.3 per cent to 7.6 per cent
More importantly, ACE Unit patients have a 34 per cent increased likelihood of returning home after their stay in hospital and patient satisfaction rates have risen to as high as 100 per cent. Rebecca Ramsden, Nurse Practitioner on the unit, says staff members have embraced the new approach.
“This new strategy has ignited a passion in all of us for providing excellent care for older patients with a focus on maintaining their functional abilities. We have seen significant changes,” says Ramsden.
But change in the approach to geriatric care goes beyond the numbers, says Dr. Samir Sinha, Director of Geriatrics. He notes there has been a cultural change too.
“Staff members are now challenged to think about the older population with a focused approach and a geriatric lens, and they are seeing the enormous rewards that come with doing so” says Dr. Sinha.
The cultural shift has happened through formal and informal education. Staff members have enhanced their skills in geriatric care. The team-approach means there is a greater focus on early and comprehensive discharge planning and improved communication with patients and their families.
The team also successfully developed and implemented evidenced-based, best practice care plans. These plans offer a standard of care for common geriatric syndromes.
For Social Worker, Alana Weinstein, the real success of the ACE Unit has been watching older patients return home to their family and friends so they can continue to lead active, healthy lives.
“By adapting our system to meet the needs of these patients, we are helping them preserve their independence, which is what ACE is all about,” says Weinstein.