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