استعرض مصدر AN OVERVIEW OF MOUNT SINAI HOSPITAL’S ACUTE CARE FOR ELDERS (ACE) STRATEGY


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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


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