ACUTE CARE FOR THE ELDERLY
ACUTE CARE FOR THE ELDERLY - OCTOBER 2015 VERSION 7 - WWW.KOAWATEA.CO.NZ
Health System Improvement Guide
EXECUTIVE SUMMARY
“The right patient, the right place, the right time….” are words that are often heard in health care. During the winters of 2012 and 2013, acute geriatric patients were not in the ‘right place’ within Middlemore Hospital. This vulnerable patient group was spread across general medical services with no coordinated approach to care.
The Acute Care for the Elderly (ACE) model was established in 13 of the 26 beds in Ward 5 in May 2013. Its aim was to improve care for complex elderly patients aged 85 and over by creating a multidisciplinary acute geriatric unit to coordinate acute care with rehabilitation services. The specific objectives of the project were to:
- » decrease the ACE to Assessment, Treatment & Rehabilitation Unit (AT&R) average length of stay (LOS) from 25 to 20 days
- » decrease the ACE average LOS from 8.6 to 7 days
- » decrease the readmission rate from 6% to 4%
- » decrease the institutionalisation rate from 14% to 8%.
The changes made from the traditional model of care were to have the patient managed under the care of a geriatrician, provide early intensive multidisciplinary input to prevent functional decline, provide acute care and rehabilitative care within the same ward, eliminate a transition of care and to better coordinate the multidisciplinary team input to return the patient home. By the end of 2014, the ACE project had achieved its objectives in reducing the ACE to AT&R average LOS and the rate of institutionalisation. It had also made substantial reductions in the average acute LOS and the readmission rate (Table 1, p. 5).
ACE benefits patients. Patients are more likely to return to their own homes, and less likely to be readmitted to hospital within seven days. The ACE team prioritise family meetings for all patients to help family members support patients at home after discharge. The early rehabilitation intervention stops functional decline for the patients, helping to avoid hospital admissions.
There are also benefits for the healthcare provider, Counties Manukau Health (CM Health). ACE saves CM Health $698,500 per year in bed days and funding for residential and private hospital care by reducing the average length of stay, the rate of readmission, and the number of patients who need institutionalised care. Taking into account the additional investment of $389,490 per year for staffi ng under the ACE model of care, the net projected annual savings are $309,010 per year (Table 1, p. 5).
رابط
http://koawatea.co.nz/wp-content/uploads/2015/06/ACE_Final.pdf
