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ACE Program Improves Quality and Patient Care for Elderly Patients

January 24, 2016
Caregiver holding a patient's hand

He was 89 years old, and lived alone in Springfield. A fractured ankle, suffered in a fall, had brought him to Baystate Medical Center. It was the latest of many hospitalizations. But this time would be different.

This time, he would be in the care of the multidisciplinary team that staffs the new Acute Care for Elders (ACE) Unit pilot program at Baystate Medical Center.

ACE Medical Director Rebecca Starr, MD and physician’s assistant Heidi Ann Courtney, PA, determined that their patient was taking 27 different prescription medications – leaving him so debilitated and confused, by his own admission, that he simply “took a handful” of random doses daily.

A thoughtful, intensive intervention by the ACE team – involving Starr and Courtney as well as pharmacists, nurses, social workers, and other professionals – helped the patient regain his mobility, control his pain, and access the community support he would need to live safely and independently at home. He was discharged by the ACE team after a few days on the ACE Unit – functionally, nutritionally, and cognitively improved, and on only 10 medications.

Positive Metrics

Elders often arrive at the hospital with multiple, simultaneous health, safety, and functionality challenges, says Andrew Artenstein, MD, FACP, FIDSA, chair of the Department of Medicine at Baystate Medical Center.

“The ACE team embraces each patient in a truly multidisciplinary care model – treating the whole patient and addressing symptoms and needs both individually and collectively.”

Nearly 400 patients, all over the age of 70, have been treated in the ACE Unit since September 2014, when it opened as a pilot program on Springfield 3. Falls have been reduced by more than half, as has use of antipsychotic drugs. The number of patients suffering from delirium has been significantly reduced, and use of restraints for patient safety has been effectively eliminated:

  • Reduced falls: ACE patients fall less than half as often as adult inpatients of all ages
  • Delirium reduction: ACE patient rates declined by 30%
  • Increased discharges to home: 13% more ACE patients were discharged to the community compared to national averages for elders
  • Less restraint use: only one ACE patient was restrained, a nearly 50-fold  lower rate than other adult medical patients
  • Length of stay on the ACE Unit is nearly a day shorter than on other medical floors, and both readmission rates and costs are lower

“We’ve proven that this approach works, and the need for it will increase significantly as our population ages,” says Artenstein, noting that western Massachusetts’ elderly population – already among the highest in the state – is expected to rise by nearly 15% by 2018.

“It’s time to move out of the pilot stage and create a permanent, expanded ACE Unit.”

Donor Support Needed

Fundraising is underway to make the ACE pilot program permanent and expand the size of the unit.

“The ACE pilot has achieved so much with only seven beds dedicated to this vital service,” says Jane Albert, vice president of development for Baystate Health and executive director of Baystate Health Foundation.

“With our donors’ support, we hope to expand it to accommodate the growing need for geriatric acute care services in our community. The ACE program is a perfect example of a life-changing service that can only happen through philanthropic investment.”

Philanthropy will make it possible. Artenstein feels so strongly about the value of a permanent ACE Unit that he has led fundraising for the new facility – following his own personal gift with an impassioned appeal to colleagues in the Department of Medicine to join him in supporting the project.

“In the course of expanding the ACE Unit and making it permanent, we also plan to incorporate designated palliative care beds,” says Artenstein. “This level of multidisciplinary care can only be funded through charitable giving. We hope our community will join our clinical staff in providing the philanthropic capital needed to bring these services to more of our elderly patients.”