The UAB Medicine Acute Care for Elders (ACE) unit, the first such specialty unit in Alabama, recently celebrated its 10th anniversary. Supported by UAB Hospital-Highlands and the UAB Comprehensive Center for Healthy Aging, the unit was created to address geriatric syndromes that can negatively impact outcomes for frail, older adult patients during a hospitalization.
By utilizing an interdisciplinary care team trained in geriatrics to manage those syndromes, the unit has established best practices and a new model for inpatient geriatric care at UAB and around the nation.
The rationale for the creation of the ACE unit was rooted in demographics. A dramatic increase in the population age 65 years or older has created many challenges for patients, families, and hospitals. Nearly one in every five Americans will be 65 years or older by 2030. Recognizing that traditional models of inpatient care were not consistently focused on health conditions specific to geriatric patients, UAB Hospital – partnering with the Division of Gerontology, Geriatrics, and Palliative Care – initiated the ACE program to establish new, evidence-based methods of geriatric care.
Not long after opening its first location at UAB Hospital-Highlands, the unit moved to another floor of the hospital and provided in that new space a more “home-like” environment to promote comfort, safety, mobility, and cognitive stimulation. Among other elder-friendly amenities, the space utilizes low-glare lighting and flooring to help with low or limited vision, while large private patient rooms with sitting and sleeping areas allow families to stay close.
Emily Simmons, MSN, RN, nursing professional development specialist for UAB’s Nurses Improving Care for Healthsystem Elders (NICHE) program, has watched the ACE program expand from its early days to earn national recognition.
“The design of the unit takes into account every element of a user-friendly environment, but specifically for the unique needs of geriatric patients,” Simmons says. “We provide safety features to assist in keeping this elder population as mobile as possible. Our patients and their families are immediately put at ease when they learn that the unit – both the team who provides care and the physical space itself – was designed specifically for them. Families who have been here before are now asking as soon as they arrive at the hospital that the elderly patient be placed in the ACE unit.”
The ACE unit staff is experienced in working with this special population of patients and receives continuing geriatric education and training. The unit’s interdisciplinary team consists of geriatric and hospitalist physicians; geriatric and hospitalist nurse practitioners; nurses; physical, occupational, speech, and respiratory therapists; a registered dietician; pharmacists; an infection control nurse; social worker; care manager; pet and music therapists; an artist in residence; ACE coordinator; chaplain; and volunteers.
To help develop such a diverse team across all of UAB, a Geriatric Scholars Program (first created for nurses in 2009) was expanded in 2011 to include other licensed staff members to spread best practices throughout the organization. Geriatric scholars undertake a two-year curriculum to gain an in-depth knowledge of caring for hospitalized older adults and managing common geriatric syndromes through evidence-based care protocols. The program readies providers to obtain gerontological certification.
Because of its location and size, UAB Hospital-Highlands’ ACE unit cannot accommodate every geriatric patient admitted to UAB. In order to spread this interdisciplinary approach across UAB, team members developed a Virtual ACE Initiative that equips other locations to provide geriatric patients with the same level of care as the ACE Unit.
“That was our mission from day one,” Simmons says. “Let’s take the best practices established at the ACE unit and extend them across the UAB medical enterprise. What the ACE unit does so well and has done since the beginning, really, is provide a comprehensive, interdisciplinary team approach. The unit at Highlands has allowed us to pilot our initiatives, creating evidence-based care plans and rolling out the best practices hospital wide. Our growth has brought so much engagement and empowerment to all of our team members, and now we are sharing our experience with other health care professionals. With that kind of success, we aren’t just impacting care at UAB, we are having a positive effect on care all across the country.”
Kellie Flood, MD, founding medical director of the UAB ACE unit, now serves as the geriatric quality officer for all of UAB Hospital. From the outset, she saw the program as a basis and guide for best practices
“From day one of the ACE unit launch in 2008 at UAB, we set out to be transforming all of UAB Hospital by year three and to be nationally recognized by year five,” Flood says. “Thanks to the amazing team of folks that work on the ACE unit, those goals were not only achieved but surpassed. Outcomes demonstrating higher-valued care from the UAB ACE unit were published in 2013, and now UAB is collaborating with the American College of Surgeons to finalize geriatric best practices for surgical patients that will be published in 2019.