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. 2019 Feb 21;4(1):24.
doi: 10.3390/geriatrics4010024.

ACE Model for Older Adults in ED

Martine Sanon  1 , Ula Hwang  2   3 , Gallane Abraham  4 , Suzanne Goldhirsch  5 , Lynne D Richardson  6 ; GEDI WISE Investigators  7
Affiliations

ACE Model for Older Adults in ED

Martine Sanon et al. Geriatrics (Basel). .

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.

Keywords: ACE model; IDT; geriatric emergency care; transitional care.

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Conflict of interest statement

The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the result.

Figures

Figure 1
Figure 1
GEDI WISE IDT Algorithm: GEDI WISE: Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements; ED: emergency department; ISAR: Identification of Seniors at Risk; NP: nurse practitioner; CAM: Confusion Assessment Method; ADE: adverse drug event; SNF: Skilled Nursing Facilities; PT: physical therapist. SBT: Short Blessed Test; ADL: Activities of Daily Living; IADL: Instrumental Activities of Daily Living; PCP: Primary Care Provider; CHHA: Certified Home Health Agency.
Figure 2
Figure 2
Mount Sinai Medical Center ED visits. Period: January 2013–December 2015. Blue = SW; Orange = NP; Yellow = Rx; Green = PT.
See this image and copyright information in PMC

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