AN OVERVIEW OF MOUNT SINAI HOSPITAL’S ACUTE CARE FOR ELDERS (ACE) STRATEGY
WORKING PAPER - DO NOT CITE OR DISTRIBUTE WITHOUT PERMISSION OF THE AUTHORS 1 AN OVERVIEW OF MOUNT SINAI HOSPITAL’S ACUTE CARE FOR ELDERS (ACE) STRATEGY
Samir K. Sinha, MD, DPhil, FRCPC
Director of Geriatrics, Mount Sinai and the University Health Network Hospitals Assistant Professor of Medicine, University of Toronto and the Johns Hopkins University School of Medicine
Prepared for: The Commonwealth Fund 2014 INTERNATIONAL SYMPOSIUM ON HEALTH CARE POLICY
EXECUTIVE SUMMARY
In 2010, Toronto’s Mount Sinai Hospital launched the Acute Care for Elders (ACE) Strategy to improve how care to patients 65 and older is delivered. Under the strategy, the hospital and its home, community, and primary care partners implemented a series of evidence-informed but tailored interventions within and spanning our continuum of care.
In the emergency department, we implemented the Identification of Seniors at Risk (ISAR) High-Risk Screening System, with additional supports to high-risk older patients provided by Geriatric Emergency Management (GEM) nurses. Within our inpatient settings, we established an Acute Care for Elders (ACE) Unit for high-risk medical patients and an Orthogeriatrics Service for older patients with hip fractures, along with integrated hospital-wide Consultation Liaison Services in Geriatric Medicine, Psychiatry, and Palliative Medicine. We have also implemented the Hospital Elder Life Program (HELP) and are using Nurses Improving Care for Health System Elders (NICHE) resources to educate frontline professionals in geriatric care and benchmark our performance internationally.
A number of integrated care models were also established to emphasize transitional and ongoing home and community care supports, like our House Calls Program, which provides home-based primary and specialty care for frail housebound elders; our Home-Based Palliative Care Program; and our Integrated Client Care Program (ICCP), which provides intensive care coordination for targeted high-risk older patients who are high users of services. Most recently, we received funding from the Ministry of Health to start the Community Paramedicine Program in fiscal year 2014–2015 to support high-risk clients and high users of 911 services. (See Appendix 1 for a more detailed description of our ACE Strategy interventions.)
Our ACE Strategy links these interventions to create a more seamless, integrated delivery model spanning the continuum of care through strong partnerships with local home, community, and primary care partners. This strategy is enabled by an interprofessional, team-based approach to care, as well as a number of technological innovations (e.g., geriatricized order sets, email notification and flagging systems, risk stratification tools), with a focus on maintaining the independence of older adults in our community for as long as possible and reducing unnecessary utilization of health care services.
The strategy includes a multiyear action plan to evaluate progress and make refinements using a balanced scorecard and a benchmarking system that allows for quarterly, regional performance comparators to identify areas of improvement. Since 2009–2010, the strategy has allowed us to reduce our average total length of stay (LOS) per patient 65 and older by more than 28 percent, while our patients are now more likely to go directly home as opposed to a nursing home. Furthermore, our patients are less likely to be readmitted and are more satisfied with our care. Despite a significant regional increase in emergency department visits and overall inpatient
http://www.cfhi-fcass.ca/sf-docs/default-source/on-call/commonwealth-fund-ace-strategy-overview.pdf
