ACE Model for Older Adults in ED

Abstract

The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.

Effects of hospital pharmacist interventions on health outcomes in older polymedicated inpatients: a scoping review

“…Some studies explored the impact of simple interventions with few professionals involved [25,45,57,58], while other planned complex interventions where the pharmacist was part of a geriatric interdisciplinary team [25,28]. In other studies, pharmacists only acted on demand [56,59]. Globally, interventions developed by a pharmacist within a multidisciplinary team seem to provide greater benefits in terms of clinical outcomes and economic results than those carried out by individual pharmacists.…”

Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia

“…GEDI is a multidisciplinary team-led, patient-centred care ED intervention, developed to improve the care of frail elderly people presenting to the ED. This model of care is associated with a decreased ED length of stay, lower rate of hospitalizations and reduced health-care cost (Sanon et al, 2019; Wallis et al, 2018). The results of this study appear counter-intuitive.…”

“…Considering the high costs of ED visits and or hospitalization, as well as, the long-term health implications associated with injuries, developing strategies to prevent falls is of great importance. In addition, ED and hospital settings are a challenging and stressful environment for frail older people especially those with multiple chronic comorbidities which put them at risk of iatrogenic disease and poor health outcomes (Sanon et al, 2019). Preventive strategies that reduce injuries, ED visits and hospital admissions are vital to address the cascade of adverse health outcomes.…”

Concepts in Practice: Geriatric Emergency Departments

“…Geriatric assessment tools are used to identify at-risk older ED patients that may benefit from interventions to prevent poor outcomes such as medication interactions, falls, functional decline, and delirium. [16][17][18][19][20] Although initially developed to directly improve care for patients, these programs also can improve systems-level metrics such as hospital throughput by reducing hospital and ICU admissions. [21][22][23] The GED Accreditation requirements were designed to provide flexibility for local innovation.…”